Trichotillomania is the compulsive need to pull one's hair out. This may result not only in hair loss, but also in distress. Although often harmless manifestations of trichotillomania can be noticed in infants, this obsession generally develops at the age 9-13. This condition may be triggered either by stress, depression, or in other more grievous cases, by sexual abuse. The problem usually implies pulling one's hair from usually two sites, although it still can include a multitude of other sites. The most frequent site is the scalp. Other usual pulling sites may include eyelashes, eyebrows, arms, legs, face and even pubic hair.
Trichotillomania can cause individuals to have different sizes of hair. Thus, some are broken hair; some are of new growth, and so on. People suffering from this may be quite shameful and secretive regarding their hair-pulling condition. That may happen also because another psychological effect manifests itself by a low level of self-esteem. This can be associated with the fear of socializing or with peer shunning because of receiving negative attention. Because of the low degree of reporting, many people may feel they are the only ones with this problem. A vicious circle is thus formed. In some cases, stress and depression can lead to trichotillomania, whereas the presence of this condition in one's daily activities may cause that person to feel depressed and inadequate.
Among other medical complications, we may include permanent hair loss, repeated stress injuries, some sort of intestinal obstruction caused by trichophagia (hair eating). In case of trichophagia, individuals with trichotillomania can ingest the pulled hair which in rather extreme and unusual cases, can lead to the formation of a hairball.
Apparently, hair pulling is very much affected by the environment. In this respect, one's sedentary activities can lead to trichotillomania. An example of such sedentary activity would be sitting in one's bed, waiting for the moment to fall asleep. There can also be an extreme manifestation of TTM in patients who pull their hair out while being asleep. This is the so-called sleep-isolated trichotillomania. The condition can also be accompanied by other mental issues such as depression, anxiety or obsessive-compulsive disorder. TTM can overlap with post traumatic stress disorder. The trigger of TTM can be stress. Also, some consider that it might be genetic, or that it is a behavior copied by the child from one of the parents or from a first-degree relative, since children do tend to copy adults' behavior without understanding its causes or without expecting them to make any sense whatsoever.
How can trichotillomania be treated? The way of treatment generally depends on the patient's age. Thus, most of the pre-school age children can grow out of this habit if their condition is taken into account and there are measures taken in the sense of helping the child get rid of it. As far as young adults are concerned, if the diagnosis is established and awareness is being raised, this may serve as an important reassuring factor to the patient and his/her family. TTM can be treated in this phase even without medication. The methods of treatment may include programs of behavior modification.
So first of all, one may try a non-pharmacological approach. But if this fails, then it is advisable to consult a psychologist or a psychiatrist. If trichotillomania occurs during the adult period, it can most often be related to some other often serious psychiatric disorders and because of that one should try and refer to psychologist or a psychiatrist for treatment or evaluation. When other conditions are being treated, therefore the causes of the habit are annihilated, hair pulling can be solved.
Is there any chance of trichotillomania prognosis? If it occurs in early childhood years, i.e. before 5, this condition can confine itself primarily to a temporary phase and in this case there is no need for intervention. Like it has been previously explained, in adulthood, this condition may be a relating sign of other mental disturbances and disorders, and because of that it may last longer, until those disorders are treated successfully. The complications of TTM are rather rare, apart from some secondary infections caused by scratching or picking.