Trichotillomania (hair-pulling disorder): cuáles son sus síntomas, causas y tratamiento

Trichotillomania (trik-o-til-o-MAY-nee-uh), also called hair-pulling disorder, is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.

Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.

For some people, trichotillomania may be mild and generally manageable. For others, the compulsive urge to pull hair is overwhelming. Some treatment options have helped many people reduce their hair pulling or stop entirely.

Síntomas

Signs and symptoms of trichotillomania often include:

Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time

An increasing sense of tension before pulling, or when you try to resist pulling

A sense of pleasure or relief after the hair is pulled

Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows

Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling

Biting, chewing or eating pulled-out hair

Playing with pulled-out hair or rubbing it across your lips or face

Repeatedly trying to stop pulling out your hair or trying to do it less often without success

Significant distress or problems at work, school or in social situations related to pulling out your hair

Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.

Automatic. Some people pull their hair without even realizing they’re doing it, such as when they’re bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania can be related to emotions:

Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.

Positive feelings. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.

If you can’t stop pulling out your hair or you feel embarrassed or ashamed by your appearance as a result of your hair pulling, talk to your doctor. Trichotillomania is not just a bad habit, it’s a mental health disorder, and it’s unlikely to get better without treatment.

Factores de riesgo

These factors tend to increase the risk of trichotillomania:

Family history. Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.

Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 10 and 13 years — and it’s often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.

Other disorders. People who have trichotillomania may also have other disorders, such as depression, anxiety or obsessive-compulsive disorder (OCD).

Stress. Severely stressful situations or events may trigger trichotillomania in some people.

Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.

Diagnóstico

La evaluación para determinar si presentas tricotilomanía puede incluir:

Examinar cuánto pelo has perdido

Hacer preguntas y hablar contigo sobre tu pérdida de pelo

Eliminar otras causas posibles de arrancarte el pelo o pérdida de pelo a través de exámenes determinados por tu doctor

Identificar cualquier trastorno físico o mental que pueda asociarse con arrancarse el pelo

Usar los criterios de diagnóstico en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), publicado por American Psychiatric Association (Asociación Estadounidense de Psiquiatría)

Tratamiento

La investigación para el tratamiento de la tricotilomanía es limitada. Sin embargo, algunas opciones de tratamiento han ayudado a muchas personas a reducir o a detener por completo el hábito de arrancarse el pelo.

Terapia

Estas son algunas terapias que pueden ser beneficiosas para el tratamiento de la tricotilomanía:

Capacitación en reversión de hábitos. Esta terapia conductual es el tratamiento principal para la tricotilomanía. Aprendes a reconocer las situaciones en las que tiendes a arrancarte el cabello y cómo sustituir este hábito con otras conductas. Por ejemplo, puedes cerrar los puños por un momento para detener el impulso. También se pueden usar otras terapias junto con la capacitación en reversión de hábitos. Una variante de esta técnica se conoce como desvinculación e implica redireccionar rápidamente la mano desde tu cabello hacia otra cosa.

Terapia cognitiva. Esta terapia puede ayudarte a detectar y a analizar las ideas distorsionadas que puedas tener con relación al hábito de arrancarte el cabello.

Terapia de aceptación y compromiso. Esta terapia puede ayudarte a aceptar tus impulsos de arrancarte el cabello sin concretarlos.

Las terapias que ayudan con otros trastornos de salud mental que se relacionan con frecuencia con la tricotilomanía, como la depresión, la ansiedad y el abuso de sustancias, pueden ser una parte importante del tratamiento.

Medicamentos

Aunque no hay ningún medicamento aprobado por Food and Drug Administration (Administración de Alimentos y Medicamentos) específicamente para el tratamiento de la tricotilomanía, hay algunos que quizás ayuden a controlar ciertos síntomas.

Por ejemplo, tu doctor puede recomendarte un antidepresivo como la clomipramina (Anafranil). Otros medicamentos que la investigación sugiere pueden ser beneficiosos incluyen la N-acetilcisteína, aminoácido que afecta los neurotransmisores relacionados con el estado de ánimo y la olanzapina (Zyprexa), que es un antipsicótico atípico.

Habla con tu doctor acerca de cualquier medicamento que sugiera. Los posibles beneficios de los medicamentos siempre deben compararse con los posibles efectos secundarios.