Addiction VS. Compulsion
Insight and awareness are other main distinction factors to decide if something is compulsive or addictive. Trichotillomania is mostly undiagnosed; it is because of the lack of awareness by the public that it is a known disorder and due to the awkward and humiliating nature of the hair pulling behavior, people often suffer silently. However, individuals who involve in compulsive hair pulling know that their act is harmful to themselves and they still engage in the hair pulling behavior.
One of the DSM5 standards to diagnose trichotillomania is that the person will have tried one or more times to stop pulling hair and not successful. One can argue that addicts can also attempt to avoid being a part of addictive behavior. However, this stage of insight generally comes only after a lot of damage to both social circle and self, with input from people surrounding the addict. Generally, addicts are not aware of the problem or the damage their actions or behaviors causing to themselves and the people around them.
Is Trichotillomania a Compulsion or an Addiction?
When it comes to compulsive hair pulling, the line between compulsion and addiction becomes even vague with different opinions from experts in the field as well as the hair puller themselves as to the difference. On one hand, the pleasure factor that is frequently associated with hair pulling is completely missing in OCD and the hallmark of OCD i.e. the obsessive thoughts are rarely present in trichotillomania.
Alternatively, trichotillomania possesses some of the main symptoms of substance abuse condition and other addictive personality patterns i.e. taking part in something harmful even after knowing its negative effects, the overwhelming urge to skin picking or nail biting, feelings of inability to self-control, and relieved or pleasurable feelings that go along with and follow the action.
The personal experiences of people with trichotillomania often closely relate to the personal experiences of habitual substance abusers. People suffering from trichotillomania frequently report experiencing intense embarrassment, shame, and self-hatred as well as anger associated with hair pulling.
Several individuals having hair pulling condition will say that they will only pluck a few strands of eyebrows or eyelashes or pull a few strands of hair, and then they will find themselves pulling hair for hours and even more. They report that they feel extreme pleasure within the moment of hair pulling followed by feeling shame and grief.
Such intense feelings are not just similar to the experiences of the substance abusers but they are approx. identical. You can think of an alcohol addict who swears to have just one drink, only to end-up blacking out and results in waking up with a hangover and feeling embarrassed and guilty.
Pleasure not Pain
Where does the pleasure come from, if pleasure is one of the definite features that make trichotillomania a possible addiction? The professor of High Point Treatment Centers and Harvard Medical School, CASTLE, Dr. Joseph Shrand explains that any kind of physical pain generates a specific amount of endorphins into the blood. Endorphins are just like morphine and provide a similar pleasurable feeling. Any type of self-harm is probably a habit formed depending on the need for endorphins.
Now the question arises, can you be addicted to one of your natural body hormones, the endorphins? Likely so! Think of the addictive characteristics of gambling where there is no need for any outside hormone, or chemical or the addictive properties of “thrill-seeking” in which individuals become addicted to the production of adrenaline. The endorphin is responsible for giving us pleasure and relief from the stressful conditions and emotional pain that we may be experiencing, if only temporarily while numbing the physical pain immediately as well.
Is it really matter how we classify trichotillomania?
Being able to deal with body-focused repetitive behaviors (BFRBs) such as trichotillomania being an addiction instead of being a part of OCD, can open up new management options for trichotillomania and paths to its recovery. The more awareness and knowledge we have of trichotillomania that is often overlooked condition, we can do more specific research, and the more trial treatments, therapies, and medications we can use.