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Trichotillomania (TTM) is an impulse control disorder characterised by the repeated urge to pull out scalp hair, eyelashes, nose hair, ear hair, eyebrows or other body hair. It is believed to be related to obsessive-compulsive disorder. more...

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Most TTM sufferers live relatively normal lives, except for having bald spots on their head. Many clinicians classify TTM as a mental disorder, though the classification is debatable. Some clinicians classify TTM as a form of obsessive-compulsive disorder. Some classify TTM as a form of self-harm. Others say that TTM is no more a mental disorder than is any other habitual behavior, such as nail biting. Many TTM sufferers have relatively normal work and social lives; and TTM sufferers are not any more likely to have significant personality disorders than anyone else.

There have been recent clinical trials of drug treatment for trichotillomania, for example using anafranil, prozac, and lithium. One should use care in choosing a therapist who has specific experience and insight into the condition, lest one be overdiagnosed or overmedicated. Prozac and other similar drugs, which some professionals prescribe on a one-size-fits-all basis, tend to have limited usefulness in treating TTM, and can often have significant side effects.

A practice related to TTM is trichophagia, in which hairs are sucked and/or eaten. In extreme cases, this can lead to the development of a hairball (trichobezoar) in the abdomen, a serious condition in humans; see Rapunzel syndrome.

Treatment for Trichotillomania

Trichotillomania is classified as an Obsessive Compulsive Spectrum Disorder. Compulsive Spectrum Disorders are obsessive compulsive qualities that are related and similar to that of Obsessive Compulsive Disorder.

Habit Reversal Training

One form of treatment for Trichotillomania is Habit Reversal Training. Many patients who pull their hair don’t realize that they are doing this; it is a conditioned response. With Habit Reversal Training doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. Patients who feel the urge to pick at their hair are taught to visualize something that will get their mindset off of picking at their hair. Once they are aware of what they are doing then they are able to focus and stop themselves from the urge of picking.

Patients are also often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes.


Selective seretonin reuptake inhibitors (SSRIs) are commonly used in the treatment of trichotillomania. Antidepressants have been shown to be effective in treating both Obsessive-Compulsive Disorder and trichotillomania.


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Splitting hairs: up to 11 million Americans wrestle daily with an overwhelming urge to pluck hair from their own bodies. Here, one woman describes her
From Psychology Today, 5/1/03 by Jennifer Raikes

An eyelash takes six weeks to grow back. I learned this when I was 9 years old, me, it was the world's most important lesson. For months I had been pulling out my eyelashes and playing with them. I don't know why I started; it just felt good. Each one was interesting: There was a root, and sometimes pigment on the tip. I stared at them, lining them up in a row. Soon my eyelids were bare. Six weeks later, when I saw the tiny black dot of an emerging eyelash magnified in the mirror, my relief was intense: I hadn't permanently disfigured myself. But that little lash didn't stand a chance. I pulled it out before leaving the bathroom.

I spent the rest of my childhood battling this urge, trying everything I could fathom to stop. I smeared Vaseline on my lashes to make them harder to grasp, wore mittens while reading, even tied my wrists to my belt. My mind swirled with pep talks and admonitions. Despite daily--even hourly--resolutions to quit, my hand always sneaked back up the moment I let my guard down. Every year, I blew out my birthday candles with a wish to stop pulling. Instead, the problem spread to my eyebrows. I looked like a ghost. And I wanted to be invisible.

My parents did their best to help, consulting numerous doctors and therapists, but none had ever heard of my problem. My sixth-grade teacher drew a thickly lashed eye on my bookmark as a reminder, and only a few children mocked my naked eyes. Still, the self-consciousness and relentless sense of failure were exhausting. I had good self-discipline in general; why couldn't I control this one strange behavior?

I began to notice patterns in the pulling that persist to this day. I pull most often during passive, mentally absorbing activities such as reading, writing and watching television. The passivity fosters a sort of split consciousness. The rhythm of running my fingers over my eyebrows is soothing. One half of my mind is attuned to the texture of each hair, the tickle against my thumb. My thoughts churn with familiar dialogue: This hair feels out of place; it's too thick, too coarse. I need to get it out. Pinching index finger to thumb, I tug. The hair slips through my fingers, but I grip and pull again. In a moment of satisfaction, the hair is out. I roll it between my fingers and feel the sticky root. I bend it in an arc, testing its strength, and run it against my lips.

Despite the fact that half of my mind is absorbed in reading, my eyes focus on the little eyebrow hair I'm holding; I'm completely captivated by the filmy white casing of the root. Then, as my teeth click together, I snap awake. I've done it again. I flick the hair aside and shove my hand under my thigh. "Stop it!" I berate myself. "You can't afford to lose another one. You'll look like hell. Just read." But no sooner am I absorbed in the stow, then my hand pops back up to my brow.

This urge waxed and waned like a primal tide throughout high school. I hid my eyes beneath long bangs and heavy eyeliner. Every morning, I awoke and ran a finger over the rim of my eyelid, gauging the extent of the night's damage. Scared to death that I was crazy, I would lie in bed and think of tests to determine my sanity. Even when my younger sister started pulling her own eyebrows, I felt isolated. We didn't talk about it much. Mostly, we argued about who had borrowed the other's eye makeup. The fact that we were both using the disputed eyeliner to hide the same habit was not a uniting force. And I was guilt-sticken with the notion that I had unwittingly taught her my behavior.

It wasn't until college that I truly realized I wasn't alone. My mother mailed me a newspaper clipping about a new organization, the Trichotillomania Learning Center (TLC). It was a relief to learn that my behavior had a name. Even so, it was years before I found the courage to contact TLC. When I finally did, I experienced one of the eeriest moments of my life. The group sent me an essay in which a woman described searching for the "right" strand of hair to pull: She even imagined the color and texture of the root. How was it that I we shared such bizarre behavior? Immediately, I was hooked on learning about my disorder.

That was eight years ago, and I've since read everything I can find about trichotillomania. Hippocrates urged doctors to note whether a patient "plucks his hair," but the disorder has been almost entirely ignored by the medical community for centuries. Today, one in 50 Americans is thought to suffer from trichotillomania. It's considered an impulse-control disorder and can start as early as infancy, but it strikes most often in adolescence. Young boys and girls are afflicted about equally, but adolescent and adult women are about nine times more susceptible than their male counterparts. Trichotillomania tends to be chronic and manifests slightly differently in each of us. Sore e people pull from their scalp until they've created bare patches or made themselves entirely bald. Men often pull their beards. Eyebrows, eyelashes, pubic hair--any hair--is a target. But the fact that it feels good to pull certain hairs is one of the greatest mysteries.

It isn't yet known what causes hair-pulling, but research has uncovered structural differences in the brains of sufferers, specifically in the areas associated with motor actions. Genetics may also play a role, as is the case with obsessive-compulsive disorder and Tourette's Syndrome, both of which may involve neurological disturbances similar to trichotillomania. Stress often exacerbates the condition, and most experts consider it to be closely related to body-focused problems such as skin-picking and nail-biting.

Despite increasing knowledge about trichotillomania, ignorance about the disorder remains one of the most overwhelming problems. It wasn't even officially labeled a disorder until 1987. Still, resources are improving. With proper help, people are often able to reduce or eliminate hair-pulling, but there is no single treatment that works for everyone.

For me, recovery requires daily effort. To better cope, I began a support group with three friends in New York City, where I've met hundreds of women and men with trichotillomania. The associated shame has at times controlled their lives, impacting decisions both large and small, from whether to venture outside on a windy day to whether to marry. Greater self-awareness (I call it "hand awareness"), fostered by reporting weekly to nay support group, has helped me most. Though I continue to feel the urge to pull nearly every day, I have not caused noticeable damage in more than eight years.

For many, having trichotillomania remains their biggest secret. And for good reason: Responses to the disorder range from disgust to laughter. Still, I've also noticed that these reactions are almost inevitably followed by, "Come to think of it, I know someone who does that."


Trichotillomania Learning Center (831) 457 1004

The Hair-Pulling Problem: A Complete Guide to Trichotillomania Fred Penzel, Ph.D. (Oxford University Press, 2003)

Jennifer Raikes is a documentary filmmaker who lives in New York City. She is president of the Trichotillomania Learning Center. Her film about trichotillomania, "Bad Hair Life," is distributed by Fanlight Productions.

COPYRIGHT 2003 Sussex Publishers, Inc.
COPYRIGHT 2004 Gale Group

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