ADHD and Trichotillomania

One of the convenient things about mental health conditions is that you don’t have to choose just one.

In the case of ADHD, it’s fairly common to get a package deal. If you have ADHD, there’s a pretty good chance you have something else too.

For example, maybe you’ll get the three-part combo: take your pick of ADHD, one anxiety disorder, and one mood disorder! ADHD, social anxiety and depression? Great! ADHD, generalized anxiety disorder, and bipolar disorder? That works too!

Or consider another set of comorbid conditions: ADHD and trichotillomania. This pair is talked about less frequently than ADHD and anxiety or ADHD and depression, but it’s still one that affects the lives of many people.

Trichotillomania is also known as hair pulling disorder because it involves repeatedly pulling out one’s hairs, despite a desire to stop and despite incurring negative consequences either emotionally or in everyday life.

The DSM-5 diagnostic manual groups trichotillomania with obsessive-compulsive disorder, but the two may in fact have significant differences, including in what treatment is most effective.

That’s not to say trichotillomania doesn’t overlap with other mental health conditions.

One study by researchers at University of Chicago, Harvard Medical School and University of Cambridge surveyed 10,169 adults in the United States, finding that 1.7 percent had trichotillomania at the time of the study. Of those, a full 79 percent had comorbid mental health conditions.

Most commonly, adults with trichotillomania had anxiety, depression, OCD, PTSD, and … wait for it … ADHD! Specifically, 29 percent of study participants with trichotillomania also had ADHD. In other words, trichotillomania is a mental health condition that often has company, and in many cases that company takes the form of ADHD.

According to the authors, their results indicate that trichotillomania is “relatively common in the general population and typically characterized by moderate-high distress and high rates of comorbidity.” An additional finding of the study was that people with both trichitillomania and comorbid mental health conditions tended to be even more distressed about symptoms of trichitillomania than those of their comorbid conditions, highlighting the real impact that trichitillomania has on people’s lives and the importance of treatment.

Trichotillomania and ADHD seem to often be present together in children, too, not just adults.

A 2018 study surveyed 38 children in Croatia, all of whom had trichotillomania and were between the ages of 10 and 17. It found that 22 children had comorbid mental health conditions, with 6 having ADHD, making it the most common comorbid condition. Although that study’s sample size is much smaller than the study of adults mentioned above, and the prevalence of ADHD was somewhat lower, its results were consistent with the idea that trichotillomania and ADHD commonly occur together in children as well as adults.

The good news is that, as with ADHD, there are treatments available for trichotillomania that can relieve symptoms and improve both children’s and adults’ quality of life. These treatments can include types of therapy such as cognitive behavioral therapy and habit reversal training.

Since both ADHD and trichotillomania can take a serious toll on people’s daily lives, seeking treatment from a mental health professional is key. With comorbid mental health conditions (like the ADHD and trichotillomania pairing), it’s especially helpful to seek treatment for both conditions. Leaving either condition untreated can make it harder to treat the other, whereas treating both can lay the ground for a self-reinforcing cycle of positive mental health changes!

Image: Flickr/madamepsychosis

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