Trichotillomania (trick-o-til-o-MAY-nee-ah) is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches. Hair pulling varies greatly in its severity, location on the body, and response to treatment. For some people, at some times, trichotillomania is mild and can be quelled with a bit of extra awareness and concentration. For others, at times the urge may be so strong that it makes thinking of anything else nearly impossible.
Trichotillomania (also referred to as TTM or "trich") is currently defined as an impulse control disorder but there are still questions about how it should be classified. It may seem to resemble a habit, an addiction, a tic disorder or obsessive-compulsive disorder. Most recently, it is being conceptualized as part of a family of "body-focused repetitive behaviors" (BFRBs) along with skin picking and nail biting.
Hair Pulling: Causes
The cause of trichotillomania is not known. Research into the causes and treatments for TTM is still in the early stages. Preliminary evidence indicates TTM is a neuro-biological disorder and that genetics may play a role in its development. It is also possible that hair pulling may have several different causes, just as a cough can be caused by many different illnesses.
When and why do people pull?
While the underlying biology is not clearly understood at this time, we do know that people with trichotillomania generally have a neurologically based predisposition to pull their hair as a self-soothing mechanism. The pulling behavior serves as a coping mechanism for anxiety and other difficult emotions. It does not hurt and they are not trying to damage themselves. While the average age of onset is 11, trich can be found in children as young as one year old. Onset of trich can be triggered by simple sensory events, such as itchy eyelashes, or by stressful life events, and it can occur quite suddenly.
Is Trichotillomania just a nervous habit?
Hair pulling is not purely a "nervous" behavior, though it is sometimes triggered or exacerbated by stress. Surprisingly, hair pulling is just as often associated with other emotions such as boredom. The strong compulsion to pull out hair exceeds the normal idea of a "habit" that can be controlled through simple will power.
Is trichotillomania a sign of abuse or emotional disturbance?
Trichotillomania occurs in people who are happy and well adjusted and it may also occur during times of anxiety, stress, trauma or other emotional disturbance. Hair pulling alone is not evidence of emotional disturbance or abuse, but it does not exclude such problems either. Depression is very common in people with trichotillomania and should always be screened for at the start of treatment for TTM.
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