Trichotillomania

Trichotillomania (TTM) (wikipedia link) more commonly known as “trich” is a form of self injury characterized by repeated impulses to pull out your own hair. This may be your scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in obtrusive bald patches. There are often confusion as to whether consider TTM as a habit, an addiction, a tic disorder or an obsessive compulsive disorder as it seems to resemble all at different times. TTM often starts during the teenage years; it can be triggered by depression or stress.

Characteristics

Individuals with TTM have normal lives but they may sometimes have bald spots on their head, among their eyebrows or even their pubic hair. Furthermore there can be different psychological effects like low self esteem, often associated with being shunned by peers and the concern for socializing due to appearance. Some people with TTM try different ways to hide themselves attention by wearing hats, wigs, fake eyebrows etc. Many clinicians classify TTM as habit fever not far away from, nail biting or compulsive skin picking. These are a cross between mental disorders, such as obsessive compulsive disorder and physical disorder such as stereotypic movement disorder as the individual performs action without really knowing what he’s doing.

Treatment

Habit Reversal Training or HRT, has proved to be a successful auxiliary to medication as a way to treat TTM. With Habit Reversal Training, doctors try to train the individual to learn to realize their urge to pull and also teach them to redirect this urge. As a part of the behavioral record-keeping component of HRT, patients are often told to keep a journal of their hair-pulling episodes to keep a proper record. They are advised to keep a record of the date, time, location, and number of hairs pulled, as well as what they are thinking or feeling at the time. This can help the patient learn to identify situations where they tend to pull out their hair and develop techniques for avoiding episodes.

Treatment with clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to significantly improve symptoms.

Epidemiology

TTM is diagnosed in all age groups; it is more common during the first 20 years, with an average age of onset usually reported between 9 and 14 years of age. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female.