Trichotillomania is the loss of hair caused by a mental problem. People who suffer from it feel a constant and powerful urge to pull out their own hair, not only from the scalp but also from the eyebrows or body hair. They can't stop doing it, especially when they are under some kind of stress.

The condition has several degrees of severity. When enough hair is pulled out, bald spots appear on the scalp. These can be very embarrassing and they affect a person's social and work relationships. Some people have mild cases of trichotillomania and can generally keep it under control. Others have severe conditions and feel the desire to pull out their hair at all times. Modern medicine has several treatments that can stop the urge or at least reduce it significantly.

There are a number of symptoms of trichotillomania. The most obvious is the pulling out of hair, which typically happens from the scalp. However, other areas like the body hair or beard can also be targeted, and some people change the affected areas in time. Typically, patients find themselves under a lot of stress if they try to resist the urge to pull their hair. The tension disappears as soon as the hair is pulled out and is replaced by a feeling of pleasure. The practice will not have any visible effects at first but will eventually cause an obvious loss of hair. Bald areas can appear, the hair becomes thinner and shorter and parts of the eyebrows or eyelashes can be removed completely.

Most people who suffer from trichotillomania also display other mental conditions. They might have a pattern or ritual related to hair pulling and they sometimes bite of even eat the hair after pulling it out. Others just play with the hair or rub it on their lips. Almost all patients are aware of their condition and desperately try to stop it, without any success. Trichotillomania is often related to strong stress or other psychological problems and the patients can't resist the urge whenever they find themselves under pressure at work or at school.

Some people with trichotillomania might also bite their own nails, chew their lips or pick on their skin. The condition can also start with pulling hair from objects such as clothes, dolls or various materials. Most patients are able to hide their condition in public and only pull their own hair when nobody can see them.

There seem to be two types of hair pulling. The first one is called focused and it's an intentional act. In this case, people pull out their hair on purpose because it provides them relief in a very stressful situation that can be the desire to pull the hair itself. This can be associated with elaborate rituals or selecting a specific hair to pull. The second type is the automatic one, when the hair is pulled out unconsciously. This usually happens while reading, watching a movie or performing a boring task.

Some trichotillomania patients can also do both types of hair pulling, the focused and the automatic one, depending on the situation. Hair pulling can sometimes be a reflex, triggered by a certain body position or time of the day.

Trichotillomania is also linked with strong emotions, which are usually negative but can be positive as well. Most often, hair pulling helps people escape stressful feelings and situations such as tension, boredom, loneliness, anxiety, tension, fatigue, frustration or stress. Since the act of hair pulling provides relief and pleasure to people with trichotillomania, they can also do it when they are happy or satisfied for whatever reason, in order to stay in a positive mood for longer.

This disease is a chronic one and lasts for a long time, with various degrees of severity if left untreated. It can be affected by other factors as well. Menstruation makes it worse in women, due to hormonal imbalance. In some very rare cases, the condition goes away after a few years, without any treatment. However, it is usually cyclical, with the urge to pull hair coming and going for weeks or even years at a time.

Risk factors

Several risk factors that make trichotillomania more likely have been identified. The most important seems to be the genetic one, since people with a family history are likely to also develop the disorder.

The age is also an important factor. The onset of the condition is usually during youth, almost always between the ages of 10 and 13 years old, and tends to last until death. Hair pulling is common at a younger age as well, but in most cases it is not severe and will disappear without treatment.

Other mental problems, like obsessive-compulsive disorder (OCD), depression or anxiety, are also known to greatly increase the risk of trichotillomania. The initial trigger is usually a very stressful event or major shock.

Medical data shows that more women than men develop this condition. However, the statistics can be wrong, since studies on youngsters have revealed that boys and girl are affected in equal numbers. Adult women could simply be more likely to go to a doctor than men are.

Treatment options

The most effective treatment of trichotillomania is habit reversal training, a behaviour therapy. The idea is to teach patients another habit that does no harm in order to replace hair pulling.

The first step is to identify the specific moment when the desire to pull hair occurs. In order to ease the tension, people with trichotillomania are taught to do another habit that doesn't have any negative effects and helps them relax and remove the tension.