Trichotillomania (TTM) is an impulse disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, or other parts of the body, resulting in noticeable bald patches. It is currently defined as an impulse-control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. It is estimated to affect one to two percent of the population, or four to eleven million Americans.
Who Gets Trichotillomania?
TTM seems to strike most frequently in the pre- or early adolescent years. The typical first-time hair puller is 12 years old, although TTM has affected people as young as one and as old as seventy. It is thought that ninety percent of those with TTM are women, but research is inconclusive and it may simply be the case that men are less likely to seek treatment and can more easily hide their symptoms. A form of TTM that affects very young children appears to occur in males and females at an equal rate and seems to be more benign in nature.
How Do I Know If I Have Trichotillomania?
Although the symptoms range greatly in severity, location on the body, and response to treatment, most people with TTM pull enough hair over a long enough period of time that they have bald spots on their heads (or missing eyelashes, eyebrows, pubic, or underarm hair), which they go to great lengths to cover with hairstyles, scarves or clothing, or makeup. The persistence of the compulsion can vary considerably: For some people, at some times, it is mild and can be quelled with a bit of extra awareness and concentration. For others, at times, the urge may be so strong that it makes thinking of anything else nearly impossible.
Why Doesn’t Anyone Seem to Know about Trichotillomania?
TTM did not appear in the popular media in the United States until about 1989. As a result, many people with TTM have gone for many years without adequate Information about their condition, or appropriate treatment. Consequently, the one symptom that most people with TTM share is shame.
What Treatments Are Available?
Research into treatments for trichotillomania has grown steadily over the past decade. Although no one treatment has been found to be effective for everyone, a number of treatment options have shown promise for some people with TTM. TLC will make referrals to practitioners of any of the following therapies, at no charge.
Cognitive-Behavioral Therapy is a form of therapy that seeks to alter behavior by identifying the precise factors that trigger hair pulling and learning skills to interrupt and redirect responses to those triggers. Cognitive-behavioral should be performed by a psychologist trained in this method and well versed in trichotillomania-something that may be easier said than done, as there is not an abundance of psychologists with this specialty. The therapist will encourage hair pullers to develop an increased awareness of the times of day, emotional states, and other factors that promote hair pulling, as an important precursor to being able to control the behavior. Some hair pullers have had success with simple behavioral devices such as putting bandages on their fingers to interfere with pulling, keeping records of their hair pulling, or changing environmental cues that can trigger pulling.
A number of medications have shown promise in reducing the severity of TTM symptoms. Most of these fall under the category of selective serotonin-reuptake inhibitors (SSRIs), the most commonly known of which is Prozac. The effectiveness of these drugs for hair pulling ranges considerably. A small percentage of people find these drugs to stop their hair pulling completely, while others feel no effect at all. Still other people have found the urges to pull their hair reduced somewhat, for varying periods of time. Researchers are studying the possible benefits of combining drugs with cognitive-behavioral therapy.
Support Groups & Sharing
Many hair pullers have discovered that the shame of being alone and hiding the condition can make it even harder to focus on strategies to reduce pulling. Joining a support group can go a long way toward erasing the shame and making people with TTM feel “normal” again. TLC maintains a database of support groups around the country for people with TTM, and referrals are free. TLC will also assist with the formation of new support groups. Some support groups are entirely peer-run; others are run by a mental health professional. Many groups feature a “check-in” time-a time for members to report on their progress-which can help reduce pulling.
There are anecdotal reports that several alternative therapies, including hypnosis, biofeedback, dietary changes, and exercise, among others, have been found helpful by many people.
Questions about pharmacological treatment of trichotillomania are among the most frequently asked of TLC. Understandably, many want to know, “What can I take to make me stop pulling?”
As of yet, there is no magic pill for the treatment of trichotillomania. In fact, people respond very individually to medications, so there probably will never be a single drug that helps everyone. There is also a strong possibility that there is more than one form of trichotillomania, and that different forms will respond to different treatments.
That said, some people do benefit from drug therapies for trichotillomania, either alone or in conjunction with cognitive-behavior therapy. Many experience a reduction of the urge to pull, and some have experienced total cessation. The effect, however, is often (though not always) temporary. It can be useful to use a period of relief to explore additional treatment or support resources that may help you in the long term.
Because reaction to medications is so individual, it is often necessary for you and your doctor to try more than one drug or combination of drugs before finding one that helps. Medications in the SRI or SSRI category have shown to be the most useful to date, but results are mixed. Please see our “Clinicians’ Guides” for more detailed Information .
The use of medication for the treatment of trichotillomania in children or adolescents brings additional concerns. Very few drug trials involve children and to date there have been no studies of the use of medication for treatment of TTM in children. Due to the limited evidence supporting its effectiveness, as well as concerns about the long-term effects of medications on the developing brain, TLC’s Scientific Advisory Board advises that for most children and adolescents with trichotillomania, medications should not be used as a treatment of first choice.
It is important for you and your doctor to be aware that many people with trichotillomania suffer with additional problems, such as depression and anxiety, which should be screened for and treated. In addition to being serious or even life-threatening in their own right, the existence of additional disorders can hinder ones ability to benefit from treatment of trichotillomania.