How Depression Triggers Trichotillomania

Trichotillomania, or hair pulling disorder can cause intense emotional and psychological problems for the individual. Feelings of guilt, shame and loneliness are just some of the negative feelings associated with this condition. Not surprisingly experiencing such negative feelings toward oneself over a prolonged period of time can lead to depression. Symptoms of depression include sadness, lethargy, loss of appetite, feelings of hopelessness and failure, low self-esteem and suicidal thoughts or feelings. But what if the person has depression as a primary diagnosis? Could the depression conversely be a trigger for trichotillomania? One research study found that in a sample of 303 outpatients with major depressive Disorder (MDD), as many as 5% endorsed symptoms of trichotillomania.

When the Internal becomes External

The symptoms listed above are all experienced internally by the depressed individual, but the more tangible, visible signs of depression are expressed through the person’s behaviour. The negative thoughts and feelings, combined with the debilitating effect it has on the individual’s daily functioning can leave the person feeling like they have lost control. Often people who struggle with trichotillomania report that while pulling they experience a sense of release and a sense of control over the physical sensation of pulling. In its mildest form, pulling or twiddling the hair could just be considered a bad habit that many people engage in when tired, stressed or deep in thought. However when the physical reward experienced by the habit combats the constant intensity of negative emotions that weights heavily on the individual, they may find themselves seeking out this release more and more. According to the Oxford English Dictionary a habit is "a settled or regular tendency or practice, especially one that is hard to give up", and in psychological terms it is "an automatic reaction to a specific situation". When the person seeks out the satisfying feeling they get while pulling the behaviour becomes repetitive, and with repetition it becomes it eventually becomes habitual.

From habit to disorder

Much like an addiction, the more the person engages in hair pulling, and the more they come to expect the satisfaction or release often experienced while pulling, the stronger the urge to pick becomes. This may lead to a dependency on the behaviour to cope with negative or stressful experiences like those experienced in depression. It is this dependence and inability to stop pulling that signals that a bad habit has evolved into something much more serious. This is when the bad habit of hair pulling has developed into the clinical disorder trichotillomania.

What are the triggers?

One of the major characteristics of depression is the intense feeling of hopelessness and loss of control. People with depression tend to feel that they have no control over their lives or personal circumstances. Hair pulling is often reported to provide a feeling of control whilst engaging in the behaviour. However, afterwards feelings of shame and guilt usually follows suit. The inability to stop pulling hair then further exacerbates perceived loss of control, thereby perpetuating symptoms of depression. If the effects of hair pulling leads to balding, an already fragile self esteem and lack of motivation to engage socially can lead to an even more isolated and lonely individual. It is therefore important that an individual with depression have a good support system and access professional help as soon early in the onset of the condition as possible to prevent this debilitating cycle of negative thought-negative behaviour from developing.

Help and Support is Crucial

It is crucial that any person suffering with depression access the psychological help and support they need to overcome the negative thoughts and emotions that impact on their daily function. Cognitive behavioural therapies (CBT), as well as pharmacological mood stabilisers, are shown to be effective in the treatment of depression. CBT is also shown to be the most effective form of therapy for body-focussed repetitive behaviours (BFRBs) such as trichotillomania. It is important that health professionals are aware of the signs and symptoms of trichotillomania and how depression can trigger hair pulling. If an individual does have depression and trichotillomania it may be beneficial to get the help of a CBT expert who is also knowledgeable about hair pulling disorder, or to find a support network such as group therapy or an online support forum.