Causes

The exact cause of TTM is not fully understood, but it is believed to be a combination of factors: 

  • Genetics A family history of TTM increases the risk of developing the disorder.

  • Brain chemistry Differences in brain structure or the system involving chemical messengers (neurotransmitters) may play a role.

  • Coping mechanism Hair pulling can be a way of dealing with negative feelings such as stress, anxiety, boredom, or loneliness, or an automatic habit developed over time.

  • Co-occurring conditions TTM often appears alongside other mental health conditions like anxiety, depression, or obsessive-compulsive disorder (OCD)

Hair-pulling disorder

Hair-pulling disorder, or trichotillomania (TTM), is a mental health condition categorized as a body-focused repetitive behavior, characterized by the recurrent, irresistible urge to pull out one's own hair, leading to noticeable hair loss and significant distress or impairment in functioning. 

Symptoms

Symptoms of trichotillomania typically begin in early adolescence and can include: 

  • Repeatedly pulling out hair from any area of the body (most commonly the scalp, eyebrows, and eyelashes), resulting in patchy bald spots or thinning hair.

  • An increasing sense of tension or anxiety before pulling out the hair or when trying to resist the urge.

  • A feeling of pleasure, relief, or gratification after the hair is pulled out.

  • Repeated, unsuccessful attempts to stop or decrease the hair pulling behavior.

  • Significant distress, shame, or embarrassment due to the condition, often leading to avoidance of social situations or efforts to cover up hair loss with hats, scarves, or wigs.

  • Other behaviors like examining the hair root, playing with the pulled hair, or biting/eating the hair (trichophagia), which can lead to dangerous hairballs in the digestive tract. 

Treatments

While symptoms may vary over time, the disorder rarely goes away without treatment and is often a long-term condition. The most effective approach generally involves a combination of therapy and sometimes medication. 

  • Habit Reversal Training (HRT) This specialized form of cognitive behavioral therapy (CBT) is the primary treatment. It teaches individuals to:

    • Become aware of the triggers (situations, emotions, or physical sensations) that lead to hair pulling.

    • Develop a competing response, such as clenching their fists or squeezing a stress ball for a minute when the urge to pull arises, to interrupt the behavior.

  • Medication No medications are specifically FDA-approved for TTM, but certain drugs may help manage accompanying symptoms like anxiety or depression. Options may include:

    • Antidepressants, such as SSRIs like fluoxetine or sertraline.

    • The amino acid supplement N-acetylcysteine (NAC), which has shown promise in reducing hair-pulling symptoms in some studies.

  • Support Opening up to trusted individuals and joining support groups can provide emotional support and valuable coping strategies. Resources can be found via organizations such as The TLC Foundation for BFRBs. 

Early diagnosis and treatment improve the prognosis and help prevent potential complications like permanent hair loss or digestive issues from ingesting hair.