Trichotillomania is a rare impulse control disorder in which the sufferer compulsively pulls out his or her own hair. People with trichotillomania most commonly pull hair from their scalp, eyelashes, eyebrows, or pubic area. While most people with trichotillomania pluck each hair out at the roots, others may pull out large handfuls at a time.
Trichotillomania usually begins in childhood or adolescence, frequently coinciding with the onset of puberty. While some children develop hair-pulling habits that subside with age, other individuals continue the behavior throughout adulthood. It is estimated that between one and three percent of Americans suffer from trichotillomania. Of those individuals, approximately 80% are women.
The direct causes of trichotillomania are unknown; however, many people with the condition also experience similar impulse control disorders, such as skin-picking and nail-biting. In many cases, the individuals suffer from depressive disorder or obsessive-compulsive disorder as well. Some evidence suggests that trichotillomania may be genetic or the result of a chemical imbalance. Stress is also believed to play a large role, as periods of high stress have been known to heighten the condition.
People with trichotillomania are often embarrassed or ashamed about their behavior, leading them to hide it from others. Because of this, low self-esteem is very common among sufferers. Furthermore, the compulsive removal of hair can lead to bald patches on the scalp or eyebrows, which contribute to the sufferer's embarrassment and depression.
In some cases, trichotillomania is accompanied by trichophagia, or the swallowing of extracted hair. This can result in the formation of a gastric bezoar, also known as a hairball. Gastric bezoars are extremely dangerous and may require surgical removal to prevent intestinal blockage.
Because trichotillomania is a behavioral disorder, treatment is usually psychological. The most successful form of treatment, known as Habit Reversal Training (HRT), focuses on increasing the patients' awareness of when and why they pull their hair out. Psychologists then aim to train patients to redirect the impulse. In some cases, antidepressants are also effective in treating trichotillomania.