Condition that makes people pluck their hair

Since she was a teenager, Sue Mwongeli, 27, knew that there was something amiss. Whenever she was under stress or idle, she would pull her hair. A lot of it. Her hairline and a section on the left side of her head bear the brunt of those actions.

On a particular day in 2015, she decided to go online in search of answers.

“I was 22 then and I was working as a house help in Lebanon. After completing my daily household chores, there was nothing much to do during my downtime. Unconsciously, I would start pulling my hair, strand by strand. I was desperate to stop it but I couldn’t,” she says.
She describes it as an irresistible urge.

“It starts as a physical sensation like there is a problem with a single strand of hair and by the time I take note, I have pulled quite a lot of it. Sometimes, I will be sitting down somewhere and it is only when I stand to leave that I notice a handful of hair on the floor. There is the satisfaction that comes with it but you also question: ‘Why does this happen to me? How can I make it stop?’” she says.

Her search led her to discover one condition — trichotillomania, a compulsion to pull one’s hair.

Dr Neema Araka, a consultant psychiatrist, says that trichotillomania is a rare mental health condition that affects one in every 50 individuals.

“It is not very clear what causes trichotillomania. It could be a chemical imbalance in the brain or changes in hormones during puberty. It may also start as a way of relieving emotional distress during a difficult period. For some people, hair pulling may start innocuously as a way to relieve boredom or loneliness. Eventually, the urge becomes a compulsion and a person is no longer able to control themselves,” she says.

In most cases, according to Dr Araka, hair-pulling coincides with the onset of puberty and continues into adulthood if left untreated.

According to a study published in 2016 in the American Journal of Psychiatry, women outnumber men in reported cases of trichotillomania by four to one. The study also notes that the severity of trichotillomania can ride in waves throughout a person’s life for days, weeks, or even years at a time.
Mr Muli Musyoka, the founder and chief trichologist at the Nairobi-based Hairhub Trichology Centre, has dealt with many patients exhibiting symptoms of the condition.

“I have been in the field for more than a decade and over the years, I have seen individuals with patches of hair loss. For some, it is the scalp, eyelashes, eyebrows, beards, armpits, or the pubic area. There are clients who confess to going to bed early so they can pull their hair,” he says.

Although trichotillomania is a rare condition, Mr Muli says that there is an increase in cases, especially among young people.

“Rarely do people say that they are pulling their hair. So, we have to listen, ask questions and watch for the tell-tale signs. Some clients don’t accept the diagnosis; so we have to take it slowly by starting with social treatments. Nowadays, I see at least three patients suffering from trichotillomania every month,” he says.

The denial, a feeling Ms Mwongeli has battled with, is inked on the mystery that is the condition.

“I don’t know anyone else who pulls their hair and before 2015, I didn’t even know that there was a name for my habits. Whenever I tell people about hair-pulling, the most common response I get besides weird stares is why I cannot stop pulling it. At the salon, I am forced to say that I am breastfeeding so that I don’t make the hairdresser uncomfortable,” she says.

For people with trichotillomania, Dr Araka says, resisting the urge to pull their hair is as hard as resisting scratching itchy skin.

“With the right help, it is possible to overcome the urge and allow hair to grow back. Patients with mild trichotillomania can adopt alternative coping strategies for responding to stressful situations like squeezing a ball, breathing exercises, relaxation techniques, or adopting anxiety-relieving techniques.

Besides this, it is important to see a therapist to learn how to plan a replacement habit,” she offers.
Although Ms Mwongeli cannot afford to pay for therapy sessions to deal with issues such as anxiety attacks and stress – issues that she battled with since childhood – she has over time learnt how to fight the urge to pull her hair.

“I practise self-affirmations. Every day, I tell myself that I am brave, confident, and beautiful. I also try to keep myself busy and focused on whatever task I have at hand. This helps,” she says.

Mr Muli suggests protective hairstyles for women, keeping hair short, and talking to a specialist about the triggers.

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