Dr. Marla Deibler

More with Marla Deibler, PsyD, on the hair-pulling disorder trichotillomania. For our first post on this topic, see When Hair Pulling Is A Problem and our second post, Cause and Treatment Of Trichotillomania.

Can you share with us something about the emotional states of those who have this disorder?

Those with trichotillomania tend to be conscientious, kind, sensitive, goal-oriented individuals. They tend toward anxiety, which sometimes drives the behavior; however, mood states do not always drive the behavior.

For some, feelings serve as a trigger for the behavior, that is, they’re anxious, bored, tired, frustrated, and so on, while others may be triggered by sensations, thoughts, posturing, or environment.

What is often striking about these individuals is the personal toll the disorder can have.  The shame, embarrassment, and lack of self-acceptance is very significant for many who struggle with this. This is why I find it so important to have a community of those with trichotillomania to share experiences and learn that they are not alone and that they are beautiful, worthwhile people. 

For this reason, we run a free, monthly support group for the community, those who are our patients as well as those who are not. I find that these groups (as well as the TLC conferences for the same reason) to be the most emotionally moving and cathartic for patients, more than any other patient group.

You shared with us some information about the problem of ingesting hair, which can lead to hair balls. This can cause serious physical problems and may require surgery.

Yes, I have seen three cases involving trichobezoar. It is important to ask patients with trichotillomania about ingesting hair.  Those who ingest hair are at risk for developing a trichobezoar, or hair ball, which can cause intestinal obstruction, ulceration, or perforation.

Patients will typically experience this as abdominal pain once there has been a narrowing of the intestines. Patients may also experience vomiting, loss of appetite, or weight loss.  Bezoars often require surgical removal.

The patients that I have seen who have had this problem had not been treated for trichotillomania and had very little insight into the problem. All were young women who, when diagnosed, were shocked and somewhat confused, as they had experienced few symptoms of obstruction, with the exception of abdominal discomfort. All were sent for immediate surgical consultation and soonafter surgery began psychiatric treatment.

You did your doctoral dissertation on trichotillomania – tell us about this.

I was fortunate to have begun my work with trichotillomania (TTM), as a doctoral student in a year of clinical training with those who pioneered this treatment and continue to be leaders in the field. Following this, I had the opportunity to bring my interest in TTM to the NIMH (National Institute of Mental Health) where I worked as a pre-doctoral research fellow studying OCD (obsessive-compulsive disorder) and Tourette’s Disorder.

It was during my time at NIMH that I conducted my dissertation research on TTM and OCD, interviewing and assessing many families with these disorders.  Since then, I continued to be interested in this spectrum of disorders.  I have now seen hundreds of individuals with trichotillomania and I am proud that those with trichotillomania in our region consider us, and each other, their community, helping them gain support, acceptance, and treatment.

Can you tell us about the Center for Emotional Health?

My practice is currently staffed by 6 clinicians, all of whom are experts in cognitive behavioral therapy and current evidence-based treatments.  Each clinician has been trained in the treatment of trichotillomania and related disorders.  Although we treat a wide range of presenting problems, our center specializes in the treatment of anxiety disorders, trichotillomania (and other body-focused repetitive behaviors), OCD, compulsive hoarding, and tic disorders.

Thanks Dr. Deibler. We’re grateful that you’ve given us so much information on this not-very-well known disorder.

Learn more about Dr. Marla Deibler.

You can learn more about trichotillomania from the Center for Emotional Health’s information booklet (PDF) and from the Trichotillomania Learning Center. Dr. Deibler’s web site, her Facebook page, and her YouTube channel, and you can follow her at Twitter.