Trichotillomania: What is behind pathological hair tearing and how hairdressers can help

This article is from a German site I follow, Top Hair. 
The article has been translated into English.

​People who suffer from trichotillomania compulsively pull out their hair. A current scientific study examines how hairdressers can help.

It's a wonderful feeling when you have customers in front of you and run your fingers through their hair, moving it and feeling its structure. For some people, however, this feeling when touching their own hair is compulsively documented. They are among the approximately one to two percent in Germany who are affected by the obsessive-compulsive disorder trichotillomania: They not only feel the movement and texture of one of their hairs, but also separate and pluck it out. Not isolated and not by chance, but targeted and above all again and again and in large numbers. In the process, those affected pluck or tear out scalp hair, eyelashes or eyebrows or even pubic and armpit hair. The visible consequences such as bald spots on the head or missing eyebrows and eyelashes are a heavy burden for those affected.

Haircut as an offer of help

A visit to the hairdresser is therefore unimaginable for many years. Instead, they hide the bald spots with towels, hats or often unprofessional hairpieces and draw eyebrows with decorative cosmetics.
The only remedy is almost always behavioral therapy, with which those affected can reduce the often underlying pressure to perform and improve the disturbed impulse control. But even a carefully executed haircut and a loving hair wash and treatment can have a positive effect on the well-being of those affected, hairdresser and certified psychologist Linda Hollatz is sure.

She is doing her doctorate on this topic at the University of Cologne. With the help of two studies, she wants to raise awareness of trichotillomania and the role that hairdressers can play in dealing with the disorder: "We hope that the results will give us a better understanding of the specific personal and professional hair care needs of those affected be able to win. A next step would then be to develop hair care interventions that can help people manage their hair pulling. "

contribute to enlightenment

In the first study, those affected are asked online about their hair care behavior and whether they let other people touch them or even dare to go to a salon. “For the second, experimental study, I developed a mindfulness-based hair appointment . I train the participating hairdressers and bring them and those affected together for an appointment. Above all, this ensures privacy for those affected and the knowledge that the hairdresser is familiar with the disease and that no explanation is required on your part.”

The aim of the study is to use the specially designed treatment appointments to find out what experiences those affected have with these appointments and whether this measure has an effect on hair-pulling behavior and self-esteem. The hair-pulling behavior and self-esteem of those affected are measured before and up to 60 days after the appointment. Hairdressers participating in the study are prepared for the appointment with virtual training. In the training, Linda Hollatz provides information in eight modules about the disease, communication with those affected, mindfulness and hair cutting techniques.

Training for hairdressers

Three training rounds for hairdressers on the so-called "mindfulness-based haircut" have already been completed. According to Linda Hollatz, more will take place this spring.

The treatment she developed, which she teaches in the training courses for the study, is based on three fundamental factors: privacy, the prior knowledge of the hairdressers and sufficient time . "I would like to show that receiving treatment that is loving and mindful can help those affected to cope better with their obsessive-compulsive disorder. I have had this experience myself and now I would like to prove it scientifically,” says Linda Hollatz. "A total of around 60 participating hairdressers that I can bring together with those affected would be ideal."

So far, almost 20 hairdressers have taken part and also treated those affected according to the "mindfulness-based haircut". This also includes master hairdresser and natural hairdresser Jennifer Lohmer from Bonn. She reports: “In contrast to normal treatment , a passive role and restraint on the part of the hairdresser is particularly important. The focus is on the customer's condition and not so much on a trendy haircut. Whether or not the customer would like advice on a haircut or possible treatment of bald spots, whether she would like general communication or would prefer to be treated without further communication - all of this is carefully clarified beforehand. What I find most important is a professional and at the same time understanding attitude. Linda prepared us for this in the training. This was then very easy to implement in the actual treatment.”

trust and security
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Master hairdresser Peter Fischer from Kassel has also already completed the training, but has not yet received a treatment appointment as part of the study. However, he has been working as a natural hairdresser since 2007 and always prioritizes mindfulness when making appointments. "Time, space, peace and quiet and communication are always important factors for us in our appointments," he emphasizes. “ I want to give our customers the security that they are seen and heard, no matter what (hair) problems they come to us with . The treatment of people affected by trichotillomania was new to me in terms of the symptoms, but treating people with care was not. I find it extremely important that we hairdressers act professionally and in an informed manner when it comes to such issues.Clarification is always the be-all and end-all. The customer must know: I am taken seriously here, I can trust here, my need is recognized here. "

Education among hairdressers is another concern of the study for Linda Hollatz: “The more salons know about the disease and deal with it professionally, the better for those affected. To dare to go to the hairdresser again after many years is a huge effort. If you can even feel comfortable there and find an understanding and knowledgeable contact person, that can help to develop a positive feeling about dealing with your own hair again.”

Anyone interested in participating in the study and wanting to know more about trichotillomania can contact Linda Hollatz atresearch@lindahollatz.de or T: (040) 52 57 0022.

INFO: WHAT IS TRICHOTILLOMANIA?

​Trichotillomania is an obsessive-compulsive spectrum disorder in which sufferers pull their own hair. They cannot stop the behavior, although they suffer greatly from hair pulling and its consequences. The hairs on the scalp, eyebrows and eyelashes are most commonly pulled out. In general, however, all parts of the body where hair grows can be affected. Hair pulling is perceived as distracting, comforting, or relieving tension, which perpetuates the behavior. Acting as an act of pleasure can also play a role: Often, playing with the hair between the fingers, touching the mouth with the hair or biting the hair is simply perceived as pleasant. The action becomes an everyday ritual, for example when driving a car, reading or making a phone call.

Tips for dealing with trichotillomania sufferers

Antonia Peters, herself affected by trichotillomania for years and now chairwoman of the German Association of Compulsive Diseases, knows the needs of trichotillomania patients when they go to the hairdresser: “The feeling of shame is extremely great. Those affected often do not go to the hairdresser for years, cut their own hair, clip it and style it in such a way that bald spots are covered. Or they name other reasons for bald spots when they visit the hairdresser: hormones, medication, nutrition, allergies, metabolism, etc.

If you, as a hairdresser, discover a diffusely bald spot with many equally short stubbles, it could be trichotillomania. A possible procedure would then be to address the customer carefully, sensitively and impartially: “I see you have a thin or bald spot here. Would you like advice on this? Could it also be that it is not due to reason XYZ, but that you may have plucked hair yourself there? I've read a lot about it/I know the topic. Would you like to talk about it or may I advise you on this?”

Communicate professionalism, understanding and expertise to the customer. Offer to treat her in a separate area - if there is one - or at a marginal appointment. In such situations, those affected may be more likely to open up and express their desire to have their hair styled more easily.

During the treatment, you can always ask subtly whether certain touches are desired, such as washing or brushing. Avoid pulling the hair too hard when cutting your hair. Create positive anchors by e.g. For example, offer a light day make-up in a completely nonjudgmental manner. Build trust by taking a step back.”

INFORMATION AND HELP

German society of obsessive-compulsive disorders e. V.:
Antonia Peters, chairwoman of the DGZ e. V., is a former sufferer and trichotillomania expert with regular telephone consultation hours (free of charge and nationwide):www.zwaenge.de

Hamburg self-help group Skinpicking / Dermatillomania – Hair Pulling Disorder / Trichotillomania and other BFRBs: Currently via zoom every 2nd and 4th Monday from 7:00 p.m. to 8:30 p.m.,www.selbsthilfe-bfrb.de
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Self-help groups by zip code:
www.zwaenge.de/selbsthilfe/shg_liste/

Also, here is a link to the ADAA (Anxiety & Depression Association in America) on 
​Trichotillomania – Facts and Treatment