Also called TTM or "Trich". It is a disorder that
causes people to pull out the hair from their scalp, eyelashes, eyebrows or any
other parts of the body, resulting in noticeable bald patches, Hair pulling
varies greatly in its severity, location on the body and response to treatment.
For some people, at some times, TTM is mild and can be quelled with a bit of
extra awareness and concentration. For others, the urge may be so strong that
it makes thinking of anything else nearly impossible.
TTM is defined as an impulse control disorder but there are
still questions about how it should be classified. It may seem to resemble a
habit, an addition, a tic disorder or an obsessive-compulsive disorder. Most
recently, it is being conceptualized as part of a family of "body-focused
repetitive behaviors" (BFRBs) along with skin picking and nail biting.
How did Trichotillomania get its name?
It was named in 1889 by a French dermatologist, Francios
Hallopeau, from the Greek word for hair (trich) and to pull (tillo). Mania is
defined as Excessive and intense interest in or enthusiasm for something.
Who gets Trichotillomania?
People of all ages, gender, ethnicity, nationalities and
socio-economic backgrounds. TTM seems to
occur as frequently in boys as girls. By adulthood 80 to 90% of reported cases
are woman. It is estimated to affect one to three percent of the population or
three to nine million Americans.
Will it go away?
It is impossible to predict the duration of TTM. Without treatment, TTM tends to be a chronic
condition, that may vary in severity throughout a lifetime. However in some
cases especially infants and early childhood TTM maybe very temporary that begins and ends quite
What does Trichotillomania look like?
Most people pull enough hair that they have bold spots on
their head, which they go to great lengths to cover with hairstyles, scarves,
wigs or makeup. Others may be missing
eyelashes, eyebrows, or other body hair, which may be camouflaged with makeup,
clothing or other means.
What causes Trichotillomania?
As with many other disorders, such as alcoholism, TTM may
develop due to a combination of genetics, emotional and enviromental factors.
It is possible that hair pulling may have a number of different causes, just as
a cough can be caused by many different illnesses.
When does Trichotillomania start?
TTM can start at any age.
Most commonly starts in late childhood or early puberty (11 to 13). This
suggests that it may be triggered by hormonal shifts in some cases. However it
can start as young as infancy, when an infant is first able to reach a hand up
to tug on hair.
In some cases hair pulling begins during a time of stress
but in many others the behavior is triggered for seemly no reason. Once
begun,the TTM behavior may play a role in regulating emotions such as boredom
**More detailed info about treatments are available from TLC
Does it hurt?
Hair pulling sounds like it would be painful, however
individuals with Trich have different answers to that question. Many report
that pulling the hair from specific sites feels good -in fact, the pleasurable
feelings contribute to their difficulty in stopping the behavior. Others
describe the sensation like scratching an itch which provides a feeling of
relief. Still others say it is painful but feel compelled to pull anyway.
People with TTM trying to injure themselves?
Generally they are not trying to hurt themselves, just as
people that bite their nails are not trying to hurt themselves. Most people
with TTM are upset by the resulting damage to their appearance and make great
efforts to control or stop the behavior. Disorders that are labeled
self-injurious (self-cutting or head banging, normally have different causes
Is Trich a sign of abuse or emotional disturbance?
TTM occurs in people who are happy and well-adjusted and it
may also occur during time of anxiety, stress, trauma or other emotional
disturbances, but it does not exclude such problems either. Depression is very
common in people with Trichotillomania and should be screened for at the start
Is Trichotillomania a form of OCD?
TTM is currently categorized as an "impulsive control
disorder' not elsewhere classified. However,there is still much debate over how
to best categorize TTM. Within a single individual with TTM there is usually a
great variety of methods and reasons for pulling. TTM at time resembles OCD in
the feeling of compulsion and repetitive behavior, but the two disorders have
different symptoms and require different treatments. Sometimes, TTM resembles a tic disorder, as
the action of pulling feels automatic and is preceded by an uncomfortable
sensation that must be relieved.
Is Trichotillomania a "nervous habit"?
TTM is not purely a nervous behavior though it sometimes can
be triggered or exacerbated by stress. Hair pulling is just as often associated
with other emotions, such as boredom. The strong compulsion to pull exceeds the
normal idea of a "habit' that can be controlled through simple will power.
Is swallowing hair part of Trich?
Biting or swallowing all or part of the pulled hairs is not
uncommon. This behavior can range from harmless when hair roots are nibbled and
swallowed to dangerous when entire hair is ingested. The formation of hairballs can lead to intestinal
blockage and may require surgery. This is a rare but serious condition than can
even be fatal if not treated properly. The danger is amplified by the fact that
many people with TTM are too embarrassed to seek medical help.
How does TTM affect the them and their families?
For some TTM is a mild problem, a mere frustration. But
recent research has shown the overall impact on the sufferers and their family
tends to be more severe.
Feeling of shame about this condition are exacerbated by how
poorly it is understood by the general public and medical professionals. TTM
often causes painful isolation. Shame leads many to drastically curtail work,
social and educational pursuits. Fear of exposure also leads some individuals
to avoid vital medical care of all kinds. Hair puling can lead to great tension and unhealthy dynamics with
family. The time and expense spent covering up hair-loss and seeking treatments
are also significant.
What treatments are available?
Treatment for TTM has grown steadily over this last decade.
No single treatment has been found that to be effective for everyone however, a
number of treatment options show great promise for people with TTM. We will be
discussing the treatment option next. This will include a brief overview of the
most well established treatment approaches.
CBT therapy seeks to alter behavior by identifying the
precise factors that trigger hair pulling and learning the skills to interrupt
and redirect responses to those triggers.
CBT should be performed by a psychologist trained in this method and
well versed in Trichotillomania. There are not an abundance of psychologists
with this specialty but TLC will provide referrals to any local providers and
is working to train more therapists in this field.
A number of medications have shown promise by reducing the
severity of the TTM symptoms in some individuals. The antidepressant,
clompramine and the amino acid, N-acetyl cysteine, have shown the strongest
benefit. A category of medication of
medications referred to as selective serotonin-reuptake inhibitors (SSRIs) the
most commonly known of which is Prozac, have shown mixed results. A small percentage of people find these drugs
stop their hair pulling completely while others feel no result..
Support Groups ans Sharing
Many hair pullers have discovered that the shame of being
alone and hiding the condition can make it even harder to focus on the
strategies to reduce pulling. Joining a support group can go a long way toward
easing their shame and putting their TTM in perspective. TLC maintains a
database of support groups around country for people with TTM and referrals are
There are scattered reports that some people with TTM have
been helped with a variety of alternative therapies. Such as Hypnosis,
Biofeedback, Dietary changes and exercise, among others. While interesting,
these therapies have yet to be subject to systematic scrutiny and thus remains
to be questionable about their use fullness.
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