There is a very secretive disorder playing itself out in bedrooms and bathrooms across the
world. It is done in private and is often times denied by the sufferer and hidden from others including
loved ones. This disorder is often times so shameful that the afflicted person will turn to substance
abuse to help calm the feelings of shame and guilt, many times to no avail. So what is this disorder
you ask. Trichotilliomania, or TTM, is defined as the recurrent, compulsive pulling of one's own hair
resulting in observable hair loss.
Hair can be pulled from any place on the body that has hair, the most common areas though are
the face, scalp, eyebrows and eyelashes. Other areas that are sometimes affected are the armpits,
pubic area and the perirectal region. Tweezers, pins or fingernails are usually used to remove the
targeted hair. Individuals with Trichotillomania often begin with self-stroking or "grooming"
responses such as hair twirling, and eyebrow caressing. These actions are used to find the perfect
clump of hair that will be pulled in the future. A hair pulling episode is usually preceded by an
increase in tension and a strong urge to pull. Following the pull, there is usually a sensation of relief
or pleasure. There are a number of people with Trichotilliomania that do not actually pull the hair but engage in
elaborate hair cutting episodes that are intended to bring about perfect symmetry. These episodes of
cutting or pulling can occur over a several hour period with the individual entering a trance-like state
where it seems as though only a few minutes have passed. Generally this will happen when the
person is alone while watching TV, reading, talking on the phone, driving or while getting ready in
There is no absolute cause for obsessive hair pulling. Through much research there is some evidence
that brain function and structure may be involved in some people with this disorder. CAT scans of
compulsive hair pulling patients are significantly different than the general population and resemble the brains of those
with other psychiatric disorders such as Tourette's which leads doctors to look closer at brain
anatomy and physiology. There is also some evidence that strep infections may be involved in early
onset, that is onset of Trichotillomania early in childhood.
Generally the onset does occur in childhood or adolescence, however there are some cases where
hair pulling compulsion is not diagnosed until adulthood. At one time it was thought to exist in only 0.03-0.2%
of the population, but now it is believed to be present in 2-3% of the population and is an equal
opportunity destroyer in childhood where the male to female ratio is 1:1. As adulthood draws near
though, there is a shift in the ratio weighing heavier on the female side.
There are several different treatment modalities available, though each case needs to be
examined on an individual basis. Habit reversal training is an effective treatment that involves first
becoming more consciously aware of situations and events that trigger hair pulling then learning to
utilize alternative behaviors in response to these situations. Another common cure is the
stimulus control technique which utilizes specific physical items as "habit blockers" to restrict the
ability to pull hair out.
There are many complications resulting from Trichotillomania including alopecia (baldness),
slowed or stopped hair growth, and changes of hair texture or color. There is also a risk of infection
or scarring from the compulsive pulling and digging to get the targeted hair and follicle out of the skin.
There are a number of people who actually eat the hair that has been pulled out, these people run the
risk of stomach pain, gastrointestinal obstruction, peritonitis and in rare cases death. There is also
a risk of carpal tunnel disorder or other neuromuscular problems from the repetitive motion of pulling
It is very important to remember that compulsive hairpulling is not a solitary disorder, it usually coexists with other
psychiatric disorders such as anxiety disorders, depression, eating disorders, ADD, Tourette's
disorder and body dismorphic disorder. People with trichotillomania usually also suffer from anxiety
and substance abuse. However, in many cases the shame associated with TTM is the greatest
debilitating effect which will drive the person to deny any problems. They may also try to camouflage
the hair loss by wearing hats, scarves, false lashes and tattooed eyebrows.
Trichotillomania can be a life changing, and sometimes life ending disorder. It needs to be treated
by a professional who is trained in the diagnosis and treatment of obsessive compulsive disorders.
It is not something that can be changed with will power. Many of the people affected by obsessive hair pulling tend to
have a perfectionist personality and believe that they can fix themselves, to no avail. So if you have
an up close and personal relationship with your magnifying mirror and your tweezers to the point that
you spend more time with them than your loved ones, you may have a problem that needs to be