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Some Basic Facts

Trichotillomania is a condition where someone has the irresistible urge to pull their own hair out.  It affects up to 2% of the population and is more common in females.   It is also known as TTM, Trich or Tricho.

What are the signs?

One of our clients with TTM
One of our clients with TTM

Hair pulling commonly starts at the ages of 12 or 13 and can coincide with puberty.  There are varying degrees of severity.  The most common areas to pull from are behind the ears and the crown or top of the scalp.  Some people will continuously pull from the same areas and others will move around the scalp.

Visible hair loss is inevitable from repeated pulling but people with Trich tend to become masters at disguising it by having their hair in a certain style or by using make up to cover the patches. However it’s very hard to manage the pulling without proper support, so in many cases the area of pulling can increase dramatically over a period of time.

Varying degrees of severity of TTM

Everyone is different – some pull regularly every day while others may have longer spells between pulling. Some pull from specific areas and if done frequently this can lead to a completely bare patch in one place while the rest of the head is unaffected. Some start in one place and gradually work outwards so that a larger and larger area becomes sparse, or in extreme cases, bare. The more intense the pulling the more likely that permanent damage can be done. While the scalp is the most common place, there are some who pull from their eyebrows and eyelashes – either instead of or as well as the scalp.

Awareness – public and professional

For a long time, little was known about TTM and finding out about it was difficult. Most people hadn’t heard of it, even doctors, and many sufferers thought themselves unique. Thankfully in recent years there has been much more information available and more and more people are aware of it.

It is often grouped with Obsessive Compulsive Disorders, though experts still argue about that. The medical profession in general seem to have a better awareness and understanding. There are now forums on the internet offering information and advice, and many sufferers are posting videos on sites like Youtube where they describe their condition and the ups and down of fighting it.  It has been written about in various magazines and newspapers and has been featured on TV shows like This Morning and Embarrassing Illness.

However despite this increased awareness,such is the isolating effect of it that most people with Trich are really shocked to discover that they are not the only one suffering from this condition, and are often very surprised to find out that it actually has a name.

There is unfortunately a degree of secrecy with trichotillomania – people are too embarrassed to mention it to anyone else and their friends or family may just assume that they have alopecia.  It’s rare for someone to openly discuss their hair pulling. We’re frequently told by new clients that we are the first people they’ve ever talked to about it, and that step alone is often a source of relief to them.

Article in New magazine about two of our clients
Article in New magazine about two of our clients

When, Where and Why?

It is usually more likely that the hair pulling happens in private –  so either in the privacy of the bedroom when no one else is there or in the bathroom where the door can be locked.  People with trich will often say that they find themselves in a trance-like state where they have spent possibly a number of hours pulling their hair out without even realising. Sometimes this happens when they’ve been reading or studying, and they only become aware of it when they see a clump of hair next to them.

They may say that it is comforting – there is a release of stress when the hair is pulled.  Though it doesn’t necessarily happen only when you are stressed or unhappy – it can also happen when you are feeling quite relaxed – but the feelings post-pulling are always very negative.  You don’t want to do it but you just can’t stop.

In some cases there is an underlying problem that triggers the first pulling event – emotional problems with family such as a death or a divorce, or problems at school or work are often mentioned – but in others there is no obvious cause. But once started the urge to pull again becomes irresistible.

Having a ongoing bad hair day

Having trich tends to really rule your day.  You’ll have to spend a considerable amount of time arranging your hair to cover the hair loss, so often clients will mention that they have to get up much earlier than normal so that they have time to do the tedious task of disguising the bare patches.  You will avoid many social situations – sleepovers are difficult and the prospect of that special someone touching your hair can fill you with dread.  Any activity which means getting your hair wet is a big no no.  A simple thing like the subject of hair in conversation can be really difficult.  Some people will even adapt their sense of fashion to accommodate wearing a hat – they don’t really want to wear a baseball cap but they need it to cover the hair loss.

My child has it – What do I do?

If you suspect your child is pulling their hair out then a telling off is not appropriate. They may already want to stop but simply can’t. They need your support and help, both personally and in order to find professional advice.

Try to be aware of how long they are spending alone in their bedroom, perhaps suggest they study or watch TV in the kitchen or sitting room. You may notice that their hands are constantly in their hair so use a distraction to get their hands away from their hair.

If your child is very young and you suspect they are pulling their hair then put some Vaseline in your hands and rub it through their hair.  This makes the hair slippy and very hard to grip on to.

Bear in mind that someone will trich will have mastered how to pull their hair with their nails being a certain length so for example if someone has always had short nails and they are suddenly longer they will find it very difficult to pull the hair. So if appropriate you may want to change their nails.

What can be done to help?

The first thing to realise is that while it can seem impossible to begin with it’s entirely possible for the pulling to be effectively managed and stopped with the right help.

A visit to your GP would be the first step.  Hopefully your GP will be aware of the condition but if not they may take the opportunity to do some research on the subject. If they aren’t aware then ask to be referred to a specialist. Thankfully it’s very rare for a GP not to be sympathetic but if you find it’s dismissed as not being important then don’t be afraid to see another doctor.

Cognitive Behavioural Therapy is commonly reported to greatly help control urges and help with managing TTM. Your GP may refer you to one or you can find one yourself. (You may find www.babcp.com useful for this.)

You should first check that the Therapist sees clients with Trich (some do and some don’t).  A number of sessions with the Therapists would normally be recommended.  The success of any type of treatment will of course be governed to a degree by the attitude of the person with the problem.  If they are willing to be helped then the chances are it will work but if they are not willing then it is unlikely to be successful.

Our own approach

Sufferers who come to us are given a number of techniques including relaxation and distraction, and are offered the chance to take part in a “buddy” system and social support meetings. We’ve also found that our Intralace System can be a valuable tool.

The Intralace has two ways of working for clients with TTM:

  • It will disguise any areas of hair loss – helping the client to look and feel good about themselves
  • It helps as a physical barrier to the pulling site – preventing the hands from reaching the hair roots and gradually breaking the habit of doing so

It is not a cure but it makes access to the areas of pulling very difficult as the scalp is covered with a mesh which in turn is covered with hair. This gives the scalp a chance to recover and for regrowth to occur if there is no permanent damage.

There is a tremendous sense of normality associated with using the system – you have a full head of hair again so it certainly reinstates some of that much-needed self esteem. And that sense of normality coupled with the physical prevention from pulling can give you the space you need to help break the cycle.

Charlotte before having an Intralace fitted
Charlotte before having an Intralace fitted
Charlotte after having an Intralace fitted
Charlotte after having an Intralace fitted

 

Many people with Trichotillomania will say that trying to manage their hair pulling without any support is extremely difficult, but the facts are that many do become “pull free” and move on with their lives – because they found the right help.

It’s best to take control of Trich rather than it controlling you – and asking for help is the first step.

Further information

Our main UK website has further information and videos about Trichotillomania including the Channel 4 documentary, Girls on the Pull.

Hair extensions are more popular than ever thanks to celebrity users including Victoria Beckham, Cheryl Cole and Britney Spears. We would all love the naturally luscious locks of Kate Middleton but more and more of us are now using hair extensions to transform the way our hair looks.  As the name implies, you can use them to extend the length of your hair but, of more relevance to anyone suffering from thinning hair, you can also use them to add volume.

However there are plenty of stories in the press about damage caused by extensions, often with dramatic pictures of celebrities showing bald patches. And particularly anyone who is already suffering from hair loss may be worried by these stories. So what’s the truth of the situation? Lets take it from the beginning.

What are hair extensions? How are they applied?

Hair extensions are lengths of real or synthetic hair that are attached to a person’s own hair to add volume or both volume and length.  The new hair is attached to your own natural strands quite close to the scalp.  There are a number of different systems for attaching them, with varying claims made for each, but the most popular tends to be bonded extensions and that is our preference too – though we use an  adhesive which is softer than most.

Roxanne Pallatt before her extensions
Roxanne Pallatt before her extensions
Roxanne Pallatt after getting extensions
Roxanne Pallatt after getting extensions

 

Will my own hair be safe?

Due largely to the occasional negative press articles, some of which are doubtless caused by journalists trying to drum up celebrity drama stories, some people are cynical how about safe extensions are. There’s no doubt that if they are not applied by a professional who is experienced in using them, and if they are not looked after properly by the wearer, then they can look terrible and sometimes cause damage. But with expertise and if reasonable care is taken then they should be both safe and attractive.

Careful application and maintenance

If you have naturally fine hair then it’s important that your extensions are a suitable weight so that your own hair can support them and so that everything looks natural. A good hair studio should also give you after-care advice on how to look after your new extensions and ensure your own hair stays in good condition. Any hair that is not growing from the root needs some extra tender loving care, so extensions need to be looked after too – using the right shampoo and the right conditioner.

When extensions are applied properly there is virtually no reason why they would damage your hair – many women use extensions to achieve a desired length with no adverse effects whatsoever. Ladies with fine or thinning hair often choose to use extensions to add volume to their hair and this is a useful part of our range of techniques for helping them look their best.

Removal is as important as application

It is just as important that the removal of your extensions is carried out by a professional so that they are carefully and painlessly removed without causing any damage to your own hair. Don’t be afraid to ask about the procedures used for the particular attachment system being recommended.

Where is the best place to go for hair extensions?

It is important to visit a reputable salon and you should be offered a consultation as the vital first step.

In recent years the demand has been mostly for real or human hair as opposed to synthetic. There are different types of real hair that can be offered so it is important to have the opportunity to both see the hair and also to ask questions about the source of it. You will also need to know about costs and the colour options available to you.

Ensure that both you and the salon are aware of the main purpose of the extensions – volume or volume and length – the consultation should confirm how many extensions you would need to add volume to your existing hair style, or how many to add both volume and length.

Enquire about having some “test extensions” applied. The market leaders in hair extensions will normally do this as part of the initial consultation – it is where some (2 or 3) extensions are added to assess if your hair is suitable. This will also allow you to experience how the attachment method feels to you. Do they feel as if they would be comfortable to sleep in? If not then that method may not be suitable for you and you should find an alternative salon.

Be Realistic

There’s no doubt that well-applied and styled extensions can transform your looks, but particularly when using them for the first time it’s advisable to be realistic, or you may be tempted to use too much weight or find that they require too much care. Once you’re comfortable with them and sure of the expertise of the salon applying them then you can start to experiment with more ambitious changes of style.

Perhaps some of the Disney Princesses gave us unrealistic expectations about our hair but having professionally applied extensions does give us more options for looking good!

 

We often get mentions in the press and sometimes in other blogs and many of them are worth reading for the stories of the women being described – these are a few of the recent ones.

Sophie Feels Better

Sophie gives us a little mention in her latest post but that’s not why it’s worth reading. Her blog tells of Sophie’s battle with and recovery from breast cancer. Since she’s Beauty Director at ELLE UK, she’s well qualified to describe the problems of maintaining your appearance during chemotherapy and her posts are both informative and inspiring for anyone going through a similar experience.

The Telegraph

They recently had an article called Why do some women go bald? which mentioned a number of different types of hair loss and featured three women sufferers, including one of our clients, Helen Lewis. Well worth a read to see that you’re not alone and that there are ways of overcoming the problem.

London Beauty Queen

A blog by the lovely Hayley which is mostly to do with the glamour side of hair, though she has interviewed Lucinda about Trichotillomania in the past. Her latest post is a full description of having extensions put in, which may well be interesting for anyone who may be thinking of having it done, whether for hair thinning or just to improve their appearance.

The Metro

Finally Lucinda herself was one of three women featured in a Mother’s Day article about three mums who made a success out of difficult circumstances.

 

Staying positive about your health and your hair

One of the hardest aspects to deal with while undergoing and recovering from Chemotherapy is the effect it has on your hair. While not all chemotherapy drugs make your hair fall out and sometimes the loss is minimal, many women will experience partial or complete hair loss during or immediately after the treatment, and this can be psychologically difficult to handle – especially at a time when you already feel worried and vulnerable.

Fortunately, permanent hair loss following chemotherapy is rare, but seeing your once-flowing locks disappear is a nasty shock and can trigger or exacerbate feelings of depression and a loss of femininity and knowing it’ll probably come back is little consolation at the time.

Why does it occur?

Chemotherapy drugs primarily attack the cancer cells in your body, but they can also affect healthy cells including those in the hair follicles. The healthy cells recover but during the treatment they can’t always function normally and with hair cells this can lead to fragile, thin or shedding hair. It may also affect other types of hair such as your eyebrows and eyelashes.

Is there any way of preventing hair from falling out

The “Cold Cap” treatment can sometimes reduce the amount of hair loss as it protects some of the follicles by preventing the drugs from getting to them by reducing the blood flow to the scalp. However not all cancer types can be treated with the cold cap in place so your Doctor or Chemotherapy nurse will let you know if it is appropriate for you.

It’s normally applied with either a gel-filled cap or a pumped coolant cap, and this has to be worn for a few hours immediately before and during the chemo treatment.

When will it start to go?

If your hair is going to fall out, it usually starts within 2-3 weeks of starting chemotherapy though it can be sooner in some cases. You’ll most likely notice any shedding when you brush or wash your hair or when you wake up in the morning.

Dealing with the impact

It’s difficult to underestimate the impact this has on your emotional well-being and sense of who you are. It can feel like a sign to you and to the rest of the world that you are ill. Hair is so bound up in what it means to be a woman that its loss takes away your sense of femininity. It can also take away your sense of being in control. And the act of worrying about it can then lead to feelings of guilt – “it’s only my hair – I should be worrying about my children or my husband or what will happen if the chemo doesn’t work”.

Everyone will react differently but one of the important keys to handling it successfully is to be prepared and decide at an early stage what you want to do and how you want to look.

Prepare in advance

Rather than letting the effects of the treatment dictate what you do and how you feel it’s often a good idea to take control and approach it on your own terms. Only you can decide the right approach for you and there is no “correct” way to deal with it but here are the three main options.

Out and battling

If you’re the type to take things head-on you may be happy to be up-front about the treatment and choose to show what’s happening to you. Some women even decide to shave off their hair as soon as it starts to fall out.

Open but disguised

If you prefer to disguise the loss in order to look more normal, but are still open about your treatment, then you may decide to wear wigs, scarves or hats. How scarves look will depend on your normal style – if you like a flowing gypsy-style it may be perfect for you – and similarly with hats of whatever style you prefer. It’s about whether you can carry it off and feel comfortable.

Fully disguised

You may however feel that you don’t want to reveal your treatment or maybe even the fact that you have cancer at all – for instance to keep the problem from children or other relatives. If that’s the case then you need a convincing cover.

You may be able to either re-style your hair in advance of chemo to match a wig of your choice – switching over once the hair loss begins so there is no discontinuity, or find a wig that matches your existing hair style. Alternatively you may prefer a more permanent solution and choose to use a hair integration system such as our Intralace System which will disguise the hair loss but also allow your own hair to grow back freely underneath. If you think this is an option you’d like to consider then naturally we’d be pleased to discuss it with you.

The Intralace won’t suit everyone but for some it does have significant advantages. I spoke to a lady recently who said she hadn’t wanted her young children to see her without hair, and she didn’t want to have to remove a scarf or wig at bed time. She told me that she found by having her hair restored through the use of the Intralace System she felt a sense of normality returning – everyone said she looked better so she felt better. She also felt that people treated her differently – they assumed all was well as she looked like her old self.

Getting back to normal afterwards

In most cases the hair fully grows back once the chemotherapy treatment is finished. but sometimes may be a different colour or texture and it can be challenge to wait for it to grow to your preferred length. One of the advantages we find with the Intralace is that your hair can successfully grow back underneath it and after a few months it will reach the stage where the system can just be removed. To help the transition appear natural you may then consider using fine, lightweight extensions until you’re happy with the length and thickness of you own natural hair.

Coping with cancer is one of the hardest things for anyone to deal with and having Chemotherapy for it brings its own challenges. Those ladies who are comfortable managing their hair loss without concealing it should certainly be admired for their bravery, but our hair is embedded in our femininity and so for many women its loss has a profound effect on their emotional health. It’s comforting to know that full regrowth is entirely possible but while you wait there are great options available to temporarily replace your crowning glory and in turn restore your confidence.

– – – –

If you’d like to read more about other women who’ve undergone chemotherapy here are some articles that have appeared in the press about clients of ours. We think they are inspiring and hope you will too.

Lynn Crisp’s story appeared in You magazine when she was a finalist in the YOU/Breast Cancer Care model competition.

Lisa Markwell told Easy Living about her journey to baldness and back.

Joanna Patrick spoke to The Observer Magazine in an article on the many forms of hair loss.

1 Comment

With all our developments – opening studios in Edinburgh and Los Angeles – over the last year or so, we’ve rather neglected Hair Loss News but now we’re getting it back on track.

We’ll be adding articles and news items here on a regular basis and coordinating with our other social media accounts on Facebook and Twitter to keep you up to date on anything relating to hair problems. Watch out for our first article tomorrow on coping with hair loss due to chemotherapy.

We’d love to hear your feedback on anything we write here – everyone has a different story and perspective on hair loss and  hearing those stories helps everyone else going through the same problem – so please feel free to share and contribute.

best wishes from Lucinda and the team

Trichotillomania is a body-focused, impulse control disorder which inevitable leads to some degree of hair loss for the sufferer.

Due to its psychological origins, however, the impact of trichotillomania is far more than just physical. It can be extremely distressing for the person with the condition, as well as making them feel so ashamed and embarrassed of their behaviour that they are afraid to tell anyone what is happening. This can lead to problems in getting a formal diagnosis of the condition.

Once trichotillomania has finally been accurately diagnosed, it is then time to think about treatment. Trichotillomania in children tends to resolve itself given time, but a doctor should be consulted if it persists.
For adults, there are a few options available, although the sufferer will need to be patient and cooperative to see results.

The following approaches have shown limited effectiveness in improving symptoms of trichotillomania, but it is important to remember that there is no ‘magic’ cure. You can try:

• Habit reversal training (HRT)
• Cognitive behavioural therapy
• Hypnosis
• Medication such as Acetylcysteine and Inositol

For an increased chance of successful treatment of trichotillomania, it is recommended to try combining medication-based treatment with behavioural therapy methods.