Saturday, 25 August 2018

Trichotillomania, also known as trich, is when someone can't resist the urge to pull out their hair.

They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes.

Trich is more common in teenagers and young adults, and tends to affect girls more often than boys.

Symptoms of trichotillomania
People with trich feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief.

A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it.

Most people with trich pull out hair from their scalp, but some pull out hair from other areas, such as their:

eyebrows
eyelashes
genital area
beard or moustache
Bald patches left on the head tend to have an unusual shape and may affect one side more than the other.

Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

Causes of trichotillomania
It's not entirely clear what causes trich. It could be:

your way of dealing with stress or anxiety
a chemical imbalance in the brain, similar to obsessive compulsive disorder (OCD)
changes in hormone levels during puberty
a type of self-harm to seek relief from emotional distress
For some people, hair pulling can be a type of addiction. The more they pull their hair out, the more they want to keep doing it.

When to see a GP
See your GP if you're pulling your hair out or if you notice that your child is.

You should also see your GP if you or your child has a habit of eating hair. This can cause hairballs to form in the stomach, leading to serious illness.

Your GP may examine areas where the hair is missing to check that nothing else is causing the hair to come out, such as a skin infection.

If your GP thinks you have trich, you may be referred for a type of treatment called cognitive behavioural therapy (CBT).

Treating trichotillomania
Trich is commonly treated using a type of CBT called habit reversal training.

This aims to help you replace a bad habit with something that's not harmful. Treatment usually involves:

keeping a diary of your hair pulling
working out the triggers for your hair pulling and learning how to avoid them
replacing hair pulling with another action, like squeezing a stress ball
involving loved ones to provide emotional support and encouragement
Antidepressants are no longer considered to be an effective treatment for trich.

Things you can try yourself
Here are some tips from people with trich that may help when you feel the urge to pull your hair:

squeeze a stress ball or something similar
form a ball with your fist and tighten the muscles in that arm
use a fidget toy
wear a bandana or a tight-fitting hat, such as a beanie
come up with a saying that you repeat out loud until the urge to pull passes
take a soothing bath to ease any stress or anxiety
practise deep breathing until the urge to pull goes away
exercise
put plasters on your fingertips
cut your hair short
Getting support
It may also help to open up about your trich to people you trust, as hiding it can sometimes make your anxiety worse.

Many people who have learned to manage their trich say that speaking to others about the condition led to a reduction in hair pulling.

The charity Trichotillomania Support has a busy online forum where you can get advice and support from other people affected by the condition. It also has lots of information on treatments and self-help advice.
Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

It usually occurs in short, unpredictable attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they start.

In most cases trigeminal neuralgia affects part or all of one side of the face, with the pain usually felt in the lower part of the face. Very occasionally it can affect both sides of the face, although not usually at the same time.

Diagram of trigeminal nerve
People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may occur hundreds of times a day.

It's possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person's quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice
See your GP if you experience frequent or persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, don't help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?
Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases trigeminal neuralgia can be caused by damage to the trigeminal nerve as a result of an underlying condition, such as multiple sclerosis (MS) or a tumour.

Typically the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can occur without any trigger at all.

Read more about the causes of trigeminal neuralgia.

Who's affected
It's not clear how many people are affected by trigeminal neuralgia, but it's thought to be rare, with around 10 people in 100,000 in the UK developing it each year.

Women tend to be affected by trigeminal neuralgia more than men, and it usually starts between the ages of 50 and 60. It's rare in adults younger than 40.

Treating trigeminal neuralgia
Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled with treatment to at least some degree.

An anticonvulsant medication called carbamazepine, which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia.

Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as necessary, sometimes for many years.

If you're entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you're advised otherwise by a doctor.

Carbamazepine wasn't originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve.

Research suggests this operation offers the best results in terms of long-term pain relief, but it's a major operation and carries a risk of potentially serious complications,

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