Trichotillomania (TTM) or ‘hair pulling disorder' is most commonly associated with anxiety and/or depression. It is difficult to get a true estimate of the problem as many people find ways to cover over the problem and just get on with their lives. However, the most conservative estimates suggest that at least one percent of the population is affected, although others go as high as three percent.
TTM is currently classified as an impulse-control disorder, although this is under review. Unlike, for example, the cosmetic plucking of eyebrows, TTM represents an irresistible urge to pull and pluck hair from the body - usually the face and head. Although the disorder can start in adulthood, onset is more common during adolescence and frequently follows an incident of stress or depression.
Most people with TTM pull hair from the scalp, resulting in bald patches. However, hair pulling may also involve the eyelashes and eyebrows simply because the face is exposed and accessible. Once hair is pulled the person will frequently stroke hair across the face and lips and chew or possibly swallow it.
As to the cause of TTM, well it isn't known. There is speculation that heredity plays its part, but others have variously pointed to serotonin and dopamine imbalance, nutrient deficiency, infections and environmental pollution. The fact that many of the features of TTM involve psychological factors, plus the recognized positive effects of psychological treatments, point to a strong psychological component.
When TTM first starts it is often as a reaction to stress. Hair pulling is a form of distraction and because it is frequently followed by hair chewing, or the stroking of hair across the face and lips, the combination of pulling, chewing and stroking has a pleasant and rewarding effect. This encourages further hair pulling that can quickly become habit forming. Hair pulling most frequently occurs during moments of boredom, or times when the person is occupied reading a book or watching TV, for example.
A diagnosis of trichotillomania means that the underlying causes need to be uncovered as part of the subsequent treatment process. There are different approaches to treatment, which may include antidepressants, but will almost certainly involve psychological therapy of some kind. Although Cognitive Behavioral Therapy (CBT) is the treatment of choice, there are reputed successes with alternatives such as biofeedback, hypnosis, habit reversal training and changes to diet and lifestyle.
Although hair pulling can be easily dismissed as a teen issue that will pass, it signifies something deeper. Those who suffer with the disorder already tend to feel anxious, depressed and have little in the way of self-esteem and self-worth. Continued exposure to others at a young age can add an intolerable level of humiliation, guilt and shame to the problem. For this reason, anyone with the condition needs to be reassured that treatments exist. They will also need encouragement and support in the initial stages to see their doctor as the first step in the treatment process.