Trichotillomania and Skin Picking

What is Trichotillomania (TTM)

The symptoms of Trichotillomania (pronounced: trick-oh-till-oh-may-nee-ah) range  in severity. However, its defining characteristic is the recurrent, compulsive pulling of the hair out at the root from places like the scalp, eyebrows, or eyelashes, sometimes causing baldness. Pulling may also occur from less common locations including the pubic area, perirectal area, or any other body region. After pulling their hair out, trichotillomania sufferers feel a sense of relief. Hair pulling may be a reflection of emotional or psychological distress, although the sufferer may not always be aware of this, for example, hair pulling may be a way to cope with feelings of stress or self-loathing or may be done without really thinking about it. It can result in negative feelings such as guilt, embarrassment or shame and can also lead to feelings of unattractiveness, which may lead to low self-esteem.  Some trichotillomania sufferers chew and swallow the hair they pull out. This is known as Trichophagia. The eating of hair causes hairballs called trichobezoars to form in the stomach or bowel. These hairballs can cause other symptoms including:

• feeling sick
• vomiting
• stomach pain and
• bleeding in the stomach, which can lead to anaemia

What Causes Trichotillomania?

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. 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 behaviour serves as a coping mechanism for anxiety and other difficult emotions. The onset of trichotillomania can be triggered by simple sensory events, such as itchy eyelashes, or by stressful life events, and it can occur quite suddenly 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. 

How Common is it?

Estimated prevalence in the general population is difficult to assess and varies between one in two-hundred and one in twenty-five or thirty depending on the criteria used to label the problem. The peak age of onset is 9 to 13. It is thought that women are four times more likely to be affected than men.