What is trichotillomania?
In this page we will shorten Trichotillomania to TTM. TTM is an impulse-control (this means that they are unable to stop) disorder that causes people to sub-consciously pull their hair out. People suffering with TTM are usually completely unaware that they are pulling out their hair but start to notice when their hair starts to thin and bald patches start to appear. TTM is commonly associated with depression, stress and anxiety. Hair can be pulled from the scalp, eyebrows or eyelashes. Feelings of guilt and embarrassment can be caused by this, which can have a negative effect on a person's self esteem and sociability (a persons social functioning).
TTM has very little research conducted into it, and is not very publicised. For these reasons, we feel it is important that we contribute to raising an awareness of TTM.
Who does is affect?
When comparing children, both males and females appear to be equally affected by TTM. However when comparing adults, TTM seems to be more common in females opposed to males. However it is not clear whether these figures represent those who suffer or just those who seek treatment, and it is commonly found that females are more likely to seek treatment with disorders like this.
What are the symptoms?
People who suffer from TTM mainly pull hair from their scalp but can also pull from the following areas:
- Genital area.
- Underarm area.
- Chest or tummy.
- Face (such as beard or mustache).
People who suffer from TTM often have an intense urge to pull their hair, and this urge will not subside until they have pulled out the hair. They will then feel a sense of relief after pulling out the hair. Many people compare this feeling to the feeling of an itch.
TTM can cause negative feelings, such as guilt. People may feel embarrassed or ashamed about pulling out their hair and may try to cover it or deny that they are doing it. TTM may also lead people to feel unattractive, therefore having a negative effect on their self-esteem. TTM can be a reflection of emotional and psychological distress, although the sufferer may not be aware of this.
Hair pulling may be a way to cope with feelings of stress, or self-loathing. In this way it can be seen as a type of self-harm as it can be done on purpose to cope with anxiety or stress.
Some people with TTM chew or swallow their hair after pulling it out. This is known as Trichophagia. Eating the hair causes hair balls called trichobezoars to form in the stomach or bowel.
Hair balls can cause feelings including:
- Stomach pain.
- Bleeding in the stomach - which can lead to amnaemia.
What are the causes?
TTM may be a reflection of a mental health problem. Psychological and behavioural theories suggest a person may pull their hair out as a way of relieving stress or anxiety. As TTM involves compulsive behaviour, it is believed that it may be closely related to OCD. If something goes wrong with the way that neurotransmitters work, it can cause problems such as compulsive and repetitive behaviours.
TTM may be a type of self-harm where a person is deliberately injuring themselves by pulling out their hair. This can be to seek comfort or temporary relief from an emotional distress. The pain associated with self-harm causes the brain to release chemicals called endorphins that create small bursts of "happiness". Self-harm is often accompanied with feelings of:
- Low self-esteem.
- Low mood.
Other theories suggest that:
- TTM can be caused by abnormalities in the brain - brain scans have revealed that there are some abnormalities of the brain associated with people who suffer from TTM.
- Genetics - An alteration in a particular gene can sometimes lead to TTM in some people, therefore meaning that hair-pulling can be inherited.
- A lack of serotonin (a "feel-good" chemical in the brain) - treatment with selective serotonin reuptake inhibitor (SSRI) which boosts serotonin levels have been found to be effective with people who suffer from TTM.
- Changes in hormone levels - TTM is more common around ages when hormone levels frequently change, such as during puberty.
There are many different types of treatment that a patient suffering with TTM can receive, some may be more effective than others so don't be put down if one type of treatment doesn't work for you! Remember that this is not a well researched condition and there may be more developments with treatments in the future.
This is a talking therapy that is often used to treat emotional problems and mental health conditions. Sufferers can discuss emotional issues with a specially trained therapist.
CBT (Cognitive Behavioural Therapy)
This is a type of psychotherapy that may be recommended for TTM. It can help to address personal thoughts, relationships with others and how to relate to the surrounding world.
CBT may also involve behavioural therapy. The aim is to alter the way that a person behaves, for example reducing the hair pulling behaviour. It can also be known as habit reversal therapy and can include:
- Educating about TTM and how it is treated,
- Making people more aware of when and why they pull out their hair - for example pulling out hair when they are stressed.
- Learning new responses to carry out when they are feeling the urge to pull out their hair. For example this could be clenching their hands into fists.
- Creating barriers to prevent from hair pulling, for example wearing a hat if they pull from the scalp.
- Getting parents or close friends involved in their treatment, for example they could praise and encourage the sufferer when they are not pulling out their hair.
Hypnosis can be used to alter a persons state of consciousness. While being hypnotised, it can be suggested that you change your behaviour and in the hypnotised state it may be easier to accept suggested ways to prevent hair pulling.
Finding strategies to help relax a person can be useful for controlling TTM, this is because it can decrease stress and anxiety which are common factors in causing TTM. These can include deep breathing exercises or muscle exercises.
Sufferers of TTM often experience emotional distress, such as feelings of self-loathing and guilt. It is important to receive emotional support for these feelings to help people to cope with them. This can be from family members, friends, support communities/online support groups or professional counsellors.
TTM can be particularly distressing for families of children who pull out their hair. Hair pulling can be a way for young people to communicate their feelings of depression, stress or anxiety to theiir families in a way that they cannot with words. Because of this, family therapy can be useful.
A therapist would meet the family to explore their views and relationships and understand any problems that may be occurring. This can help families to communicate with each other. This type of therapy can be particularly useful for families of young people who are experiencing severe problems, meaning that the family can work together to address the issue that is causing the hair pulling and seek support for this.
Several medications have been used to treat TTM, although not many large scale clinical trials have taken place.
- Selective Serotonin Reuptake Inhibitors (SSRI's)
- SSRI's have been used to treat TTM, although some evidence suggests that they are not always effective. This is a drug that is normally used to treat Depression and Anxiety.
- For young people, usually the recommended SSRI's are Sertraline and Fluoxetine. But these are only used under the supervision of a specialist Psychiatrist.
- This is another medicine that is recommended for TTM. It is often used to treat depression and obsessional states. Young people using this drug should be supervised by a specialist Psychiatrist.
- This drug has been tested and has proven effective for TTM.
- Other medicines:
- There is a lack of medicinal research into what medicines are effective for treatments of TTM. However, small trials have been carried out, and will continue to be researched.