Interview questions raised on hair pulling...

A student this week asked me some questions about hair pulling for a project she was working on.  In trying to answer her questions it hit me just how little we really know and investigate this condition.  She asked firstly:

What do you think triggers the beginning of trichotillomania in someone? 

 

My answer to this question was that different fields of psychology have different perspectives on it.  The neurobiologist might point to dysfunction in the basal ganglia and cerebellum which implicate the role of serotonin.  The behaviourist might see it as a random behaviour that results when an environment inadequately enforces normal behaviours so that unintended behaviours develop.  Evolutionary psychology (in which camp I place myself) might view it as a 'mental program' or an innate behaviour derived from man's ancestral past which is triggered under certain conditons.  Those triggering conditions are most threatening during a sensitive period when the young developing organism's brain is becoming wired to its environment.  If the environment is unnatural or inadequate and thwarts, prevents or does not reciprocate and support species specific behviours then a self-directed behaviour might emerge.  But I could not say why hair pulling develops over, say, nail biting or thumb sucking etc.  One of the reasons I could not say is because so little research has gone into this question, if any!  So, I want to put forward some suggestions of my own here for what they are worth.

1. no research has gone into why the lipid fat root is so valued by hair pullers.  This eating behaviour that forms part of hair pulling is often completely omitted from considerations of the condition because the focus is placed instead on coping with the social embarrassment of hair loss.

2. no research has gone into the effect of hair pulling and lipid fat hair root eating on a person's metabolic rate.

3. no research has gone into why certain kinds of hairs and certain areas of the scalp are preferred over others.

I believe that the eating component of hair pulling is an attempt to control or homeostatically regulate in some way the metabolic rate, i.e. that rate at which the body conserves or spends energy.  The implication here is that hair pulling is triggered by environmental conditions which are stressful and which the brain may interpret as conditions in which resources and social support are scarce.  Hair pulling and root eating may be an activity that aims at preserving resources and reducing exposure time to a disadvantegeous situation because it is an activity that: (a) is a form of self-feeding as well as self-grooming (b) is mode of foraging applied to the body (c) is a form of tolerating exposure to an environment in which the indivudual feels powerless by triggering behaviours that utilise grooming and feeding brain circuitry implicated in survival (d) is a way of focusing attention towards the body and away from the world because the act of pulling involves bowing the head and obtaining an object that fills the foreground.  Of course, without research pointing in this direction this is but conjecture on my part. 

The student's second question was:

How would someone with the condition overcome it?  

I suggested that unless hair pulling is engaged with early on and during the developmental period when the brain is becoming wired to its environment then it could well become a lifelong condition.  In other words, the environment needs to be altered as soon as the problem surfaces to address the triggering circumstances.  Maybe family system therapy would be the best place to start.  In short, some sort of environmental enrichment is required - a method successfully employed with captive animals that fur pull.

Maybe the moral here, is that unless we see ourselves as organisms that have developed to be sensitive to environmental signals - as animals are - we cannot hope to understand hair pulling fully.