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Spokane, Washington  Est. May 19, 1883

Hair-Pulling Shares Behavior Patterns Of Chronic Overeating

Jane E. Brody New York Times

For 14 years, Barbara K. could not resist the urge to pull the hairs from her head.

She thought of herself as “sick, flawed, strange, lacking in willpower and self-control,” she said recently.

“Until I was 23 years old, I thought I was the only person in the world with this problem,” said Barbara, who asked that her last name not be used, to protect her privacy.

The compulsion began at 9, when her parents divorced and her father remarried. The repetitive behavior helped to keep painful thoughts about her family situation from flooding her mind.

At the same time, though, it trapped her in a vicious cycle: She would pull out her hair, then get mad at herself for doing it, which lowered her self-esteem and prompted her to pull some more.

Then in 1988 she came upon a newly published book about obsessive-compulsive disorders, “The Boy Who Couldn’t Stop Washing,” by Dr. Judy Rapoport (Plume, $8.95). In it was a chapter describing Barbara’s problem and giving it a name: trichotillomania (pronounced trick-a-till-o-MAIN-eea), literally hair-pulling madness).

Just knowing she was not alone - an estimated 2 million to 4 million people in this country alone are hairpullers - helped lift her spirits, and the promise of possible treatments gave her the courage to seek professional help, which has eased, though not eliminated, her hairpulling urges.

Trichotillomania typically starts either in early childhood, before the age of 6, or during adolescence and young adulthood, from about 13 to the early 20s. In early childhood it affects boys and girls about equally, but when it begins later, about 90 percent of patients are believed to be women.

However, recent evidence suggests the disorder may be much more common among men than is thought. Men are generally more reluctant to admit the problem and, because male baldness is so common, are better at covering it up.

Barbara, who has been active in support groups for several years, explained that compulsive hairpulling is not always set off by a traumatic event. It often starts with a minor incident that calls people’s attention to their hair, like a sibling’s pulling one’s hair in a fight. Or the trigger can be something as simple as a habit of twirling one’s hair while reading.

Once it starts, stress and anxiety can make it worse.

Behavioral characteristics of hairpulling are remarkably similar to those of compulsive overeating. Hairpulling is commonly done only when the person is alone. It is often done unconsciously, for example, while a person is reading, talking on the telephone or watching television.

Barbara said hair-pulling could be such a pleasurable experience that people were unwilling to try to stop.

Scalp hair is not the only target. Some people pull out facial hairs. Others focus on body hairs. Dr. Ronald M. Winchel of the New York State Psychiatric Institute in New York said that in severe cases, “individuals may completely denude their scalp, eyebrows, eyelashes and facial hair.” Others may restrict pulling to pubic hairs.

The most common complication is the damage that hair-pulling can do to self-image, in the form of embarrassment, shame, guilt and depression. For fear of discovery or having hairless parts exposed, many avoid activities like swimming and dating.

Early-childhood trichotillomania often disappears on its own within weeks or months or goes away after a simple intervention, like reminding the child not to do it. But in adolescents and adults, the problem typically lasts for decades.

Treatments that are highly effective for some people maye limited or no benefit for others, suggesting that the disorder is complex, perhaps with several underlying causes.

Most effective has been the use of drugs like Prozac (fluoxetine), which increase serotonin levels in the brain. This and other drugs, like clomipramine, often make patients more aware of their behavior, the first step toward changing it.

Some patients, however, find that the drugs work for only a short time before the urges return. Even if these drugs, which are also antidepressants, do not stop the hairpulling, many say they provide a significant emotional lift.