The Relationship Between PTSD and Trichotillomania

Woman pulling strand of hair
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People with post-traumatic stress disorder (PTSD) have been found to be at high risk for engaging in a number of unhealthy and self-destructive behaviors; however, one behavior that has been examined less frequently is trichotillomania.

What Is Trichotillomania?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), trichotillomania is an impulse control disorder that is made up of the following symptoms:

  • Recurrent pulling out of one's hair that eventually results in some noticeable hair loss.
  • An increase in tension immediately before pulling out hair or when one tries to resist engaging in the behavior.
  • Pleasure, gratification or relief when hair is being pulled out.

In addition, to be diagnosed with trichotillomania, the symptoms described above cannot be better accounted for by some other disorder or a health condition. Also, the symptoms have to result in distress or impairment in different domains of a person's life.

Little is known about trichotillomania, but some research indicates that it occurs among 1 to 2 percent of the general population. However, there is some evidence to suggest that people with certain mental health disorders, such as PTSD, may be more likely to engage in this behavior.

PTSD and Trichotillomania

To examine the connection between traumatic exposure, PTSD, and trichotillomania, researchers at Skidmore College and Harvard Medical School and the Massachusetts General Hospital conducted a study among a group of patients seeking treatment at a trichotillomania clinic. The researchers asked these participants about their past traumatic exposure and assessed symptoms of PTSD.

They found that about 75 percent of the patients said that they had experienced at least one traumatic event in their lifetime. In addition, 19 percent met criteria for a diagnosis of PTSD. Notably, this rate of PTSD is much higher than found in the general population.

Interestingly, the researchers also found that the severity of a patient's trichotillomania was associated with less severe PTSD symptoms. According to the authors of this study, this might suggest that trichotillomania is being used to reduce stress, anxiety, and tension associated with the experience of PTSD symptoms.

Although PTSD symptoms were less severe among those with more severe trichotillomania, this doesn't necessarily mean that this behavior "works" to address PTSD symptoms. As with other self-destructive behaviors, although trichotillomania may bring about some initial reduction in distress, it doesn't allow someone to adequately process their emotions.

Not surprisingly, other studies have found that trichotillomania is related to emotional avoidance. Consequently, these emotions may eventually come back and may come back stronger. In addition, the shame that people with trichotillomania may feel as a result of losing their hair may also eventually increase distress and make some PTSD symptoms worse (for example, feeling distant from others or isolation).

Getting Help

If you suffer from PTSD and trichotillomania, it is important that you seek help. There are a number of effective treatments available for PTSD, and successful completion of these treatments may improve your response to treatments for trichotillomania or reduce the need to engage in behaviors such as trichotillomania. For example, habit reversal and other cognitive behavioral interventions have been found to be helpful for people with trichotillomania.

Certain medications also have support in the treatment of trichotillomania. In addition, some studies have shown that Acceptance and Commitment Therapy may be particularly helpful for people with trichotillomania. You can learn more about trichotillomania and its treatment from the Trichotillomania Learning Center. There are a number of helpful provider locator search engines on the Internet that can assist you in finding a treatment provider in your area.

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Article Sources

  • Begotka, A.M., Woods, D.W., & Wetterneck, C.T. (2004). The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 17-24.
  • Christenson, G.A., & Mansueto, C.S. (1999). Trichotillomania; Descriptive characteristics and phenomenology. In D.J. Stein, G.A. Christenson, & E. Hollander (Eds.), Trichotillomania (p. 1-41). Washington DC: American Psychiatric Association.
  • Gershuny, B.S., Keuthen, N.J., Gentes, E.L., Russo, A.R., Emmott, E.C., Jameson, M., Dougherty, D.D., Loh, R., & Jenike, M.A. (2006). Current posttraumatic stress disorder and history of trauma in trichotillomania. Journal of Clinical Psychology, 62, 1521-1529.
  • Twohig, M. P., & Woods, D. W. (2004). A preliminary investigation of Acceptance and Commitment Therapy and Habit Reversal as a treatment for trichotillomania. Behavior Therapy, 35, 803-820.