Trichotillomania (TTM) is a compulsive urge to pluck out hair, resulting in alopecia. It is also referred to as 'compulsive hair-pulling'. Although TTM is not an Obsessive-Compulsive Disorder (OCD), it is a disorder that involves irresistible urges and can co-occur with OCD. It can also co-occur with BDD.
Epidemiological studies now show that Trichotillomania is more common than previously thought, females having a fourfold higher incidence than males. Onset may occur in early childhood but is more often in adolescence and early adulthood.
A person with TTM sometimes experiences a build up of tension before hair-pulling that is then relieved by this behaviour. Even if there is no tension prior to plucking, the person may find plucking pleasurable. This makes the behaviour difficult to stop.
The most common places that people with TTM pull hair from are the scalp, eyelashes and eyebrows. They may also pull hair from the face, arms, legs, abdomen and pubic area. Fingers are commonly used to pull hair but some people may use tweezers. A person with TTM may also pull hair from other people (e.g. family members) or pets.
Hair sucking or chewing (sometimes resulting in hair ingestion) may also occur in people with TTM and this may lead to intestinal problems requiring surgery. Many also chew their nails, cheek and tongue.
People with TTM are very secretive about their disorder and avoid seeking treatment. They may pull hair from places that may not be noticed to avoid drawing attention to their problem (for example, a woman with long hair might pluck from the crown and then brush the hair over to hide a bald patch).
People with TTM will usually have tried stopping the behaviour themselves by a variety of ways including taping their fingers together, or wearing hats and gloves. TTM usually begins in childhood or adolescence and there is no consistent evidence to suggest that it may be more common in males or females. Evidence suggests that several biological factors (e.g. brain structure, viral infection) may be responsible for the onset of TTM. People with TTM often feel depressed, ashamed and have low self-esteem. Occupational, domestic and social functioning may also be affected. TTM can, however, be treated and controlled.
TTM research is not extensive at present and the efficacy of various treatment methods has not been compared systematically. Nevertheless, several methods may be used to treat TTM, with two or more of them often being used in combination. Behavioural treatments often employ 'habit reversal training'. This basically involves breaking down each part of the hair pulling behaviour and attempting to change it. As well as changing behaviour, cognitive-behavioural therapy (CBT) involves subjecting the person's thoughts and feelings about hair pulling to analysis and change (e.g. that pulling makes the person feel better). In an attempt to stop hair-pulling further, the person may have a hairpiece glued to the crown of their head to prevent any more hair being plucked from the area. Over time, it is hoped that this might break the pulling habit. Hypnosis may benefit some people with TTM, and drug treatment will often be employed. Successful treatment of TTM seems to be most likely with a combination of CBT and medication.
Whilst Trichotillomania has been recognised for over 100 years it has, until recently, been hidden, the rapid place in which this illness is gaining public discussion will encourage sufferers to seek treatment. The result will be help for the sufferer and greater understanding by clinicians of the dynamics and neurobiology of Trichotillomania. It is via this understanding that the aetiology may be explained and more effective treatments emerge.
If you think that you might have TTM, the first point of contact for help should be your GP. Your GP may have little or no knowledge of TTM and so you will need to describe it to them. You may find it helpful to print out this webpage and take it along with you. Many people with TTM avoid seeking help because they feel ashamed or embarrassed. As difficult as it may be to seek help, your GP is there to help you and everything you tell your GP is confidential. To help overcome the negative emotions involved in TTM, such as depression and low self-esteem, becoming involved in a trichotillomania support group is recommended.
MHC is grateful the this information provided by OCD Action.