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In a surprisingly large number of hair loss cases, stress or other mental health issues are found to be a main trigger for the condition. This can make hair loss conditions difficult to diagnose, as the problem is a psychological one rather than solely physical.

Stress-related hair loss

For conditions such as alopecia areata and telogen effluvium, it is often psychological or emotional trauma that causes the hair to start falling out. Excessive stress can cause more hairs than normal to enter the resting (telogen) phase, resulting in mass shedding a number of months later. Stressful conditions which can trigger this kind of hair loss include pregnancy, surgery and miscarriage.

Trichotillomania

This is a compulsive ‘hair pulling’ disorder, part of the impulse control group of conditions. It causes the sufferer to feel an irresistible urge to pull out hairs from their own scalp, eyelashes or eyebrows. Some people with trichotillomania often feel a sense of tension before pulling hair, or whilst trying to resist the behaviour, and a sense of relief or satisfaction afterwards.

A number of people with this condition also feel a sense of shame or embarrassment about their behaviour and attempt to hide it from others.

As with any potential medical problem, the first thing you should always do if you think you have a hair loss condition is to see your general practitioner (GP).

Although not a hair loss specialist, your family doctor should still be your first port of call as he/she can take the first steps to getting you an accurate diagnosis. Your GP may ask you about:

• Your diet
• Any medication you may be on
• Your hair care routine
• Any illnesses you may have had recently

If you’re female, your doctor may also ask you some questions about your menstrual cycle and whether you are pregnant or have recently had a child.

You can also expect your GP to carry out a physical examination, blood tests and possibly a biopsy.

Referral to a specialist

After your doctor has noted down all the basics to do with your general health and is unable to diagnose you, it is likely that he/she will refer you to a dermatologist or a trichologist (a hair loss specialist) for consultation and treatment. This is where you will find out what is causing your hair loss and whether it can be treated or not, as well as learning about your hair management options.

The way in which the normal hair growth cycle works means that everyone sheds some of their hair every day. This is totally normal and is nothing to be worried about, unless of course the hair loss is excessive.
To define whether you should be concerned that you have a hair loss condition, it can be useful to know more about the normal hair growth cycle.

Hair growth cycle – key facts:

• Approximately 85- 90 per cent of all your hair is growing at any one time. This hair is in the anagen (growth) phase.

• The anagen phase generally lasts between two and six years, but can be as much as eight

• Hair grows at a rate of around 0.5 inches (1.25cm) per month. This equates to 6 inches (15cm) a year. The speed at which hair grows slows as you age.

• Around 10-15 per cent of your hair follicles are in the resting (telogen) phase at any one time. This phase lasts for one to four months, at the end of which the telogen hairs fall out.

• Normal hair shedding results in the loss of around 50 – 100 hairs a day. Hair should not fall out in clumps; if it does, you should see your GP.

• When a hair falls out, it is replaced by a new hair and the cycle begins again

Hair loss is often associated men of a certain age, which is why hair loss in women can be so upsetting. Potentially even worse than female hair loss, however, is when a hair loss condition occurs in children.
There are many causes of hair loss in children, including:

• Alopecia areata –an autoimmune disorder which causes patchy hair loss
• Tinea capitis (ringworm) – a contagious fungal infection which shows up as scaly, round patches of hair loss on the scalp
• Telogen effluvium – a hair loss condition caused by sudden or severe stress interrupting the normal hair growth cycle
• Trichotillomania – a compulsive disorder in which the child feels the urge to pull out their own hair
• Nutritional deficiency – a less common occurrence, a lack of B vitamins (i.e. biotin) or zinc in the diet can cause hair loss
• Endocrine problems – conditions such as hypothyroidism, where the thyroid is underactive, can cause hair loss

Baby hair loss

Hair loss in very young children and babies can have non-medical causes, which often go away on their own. These causes include rubbing (friction with car seat or crib mattress) and newborn hair loss, where the hair falls out to be replaced by permanent hair.

Female hair loss can have many causes and it can often take some time to identify which ones are really to blame. One common cause is medication, which can cause side-effects including loss or damage to hair.

The way in which medication damages hair is in interrupting the natural hair growth cycle. This cycle has two main phases – anagen and telogen. The anagen phase is when the hair follicles grow, and it can last for three to four years. The telogen phase is the resting stage, when the hair follicles recover for around three months before falling out.

Medication can interfere with this cycle, either stopping the anagen phase in some way or sending too many hairs into the telogen phase. This can cause mass shedding, where a lot of hair falls out at once.

Medications

There are many medications which could cause hair loss as a side-effect in some cases. Always check with your doctor if you have any concerns.

• Anticoagulants (blood thinners)
• Epilepsy medications
• Oral contraceptives
• Acne medication
• Antidepressants
• Antifungal medications
• Antibiotics
• Hormone replacement therapy (for women – progesterone or oestrogen)
• Steroids
• Mood stabilisers
• Chemotherapy medications
• Thyroid medications
• Immunosuppressant medications
• Cholesterol-lowering medication

Trichotillomania is a hair loss condition and compulsive disorder in which a person pulls out their own hair. This kind of hair pulling can occur to the point that hair loss is noticeable to other people.

Loss of hair is obviously the first and most evident sign of trichotillomania, but what are the other symptoms? Identifying the following symptoms in a suspected sufferer can help your GP or trichologist diagnose the condition properly and distinguish it from other hair loss conditions.

Trichotillomania symptoms

A person with trichotillomania may experience:

• The irresistible urge to pull hair
• A feeling of tension before pulling hair, or when resisting
• A sense of satisfaction, relief or pleasure after giving in to the hair pulling impulse
• Bare patches on the scalp or skin where hair has been pulled out
• Other compulsive body-focused behaviour such as chewing hair, eating hair (trichophagia) inspecting hair roots and excessive playing with hair

The condition is occasionally difficult to diagnose properly because sufferers feel ashamed of their urges and attempt to hide their symptoms and behaviour from others. These people often wear hats, wigs and scarves to try to hide their hair loss.