Hair Pulling

Related disorder: Trichotillomania (TTM)

Trichotillomania (TTM) is a compulsive urge to pluck out hair, resulting in noticeable hair loss. It is also referred to as ‘compulsive hair pulling’. TTM has been classified as both one of the families of Obsessive Compulsive Disorder as well as an Impulse Control Disorder. It is a disorder that involves irresistible urges and can co-occur with OCD, BDD and Compulsive Skin Picking (CSP).

A person with TTM sometimes experiences a build up of tension before hair pulling that is then relieved by this behaviour. The pulling can be done consciously or unconsciously. Even if there is no tension prior to pulling, the person may find pulling pleasurable. This makes the behaviour difficult to stop.

The most common places that people with TTM pull hair from are the scalp, eyelashes and eyebrows. They may also pull hair from the face, arms, legs, abdomen and pubic area. Fingers are commonly used to pull hair but some people may use tweezers. A person with TTM may also pull hair from other people (eg, family members) or pets. Hair sucking or chewing (sometimes resulting in hair ingestion) may also occur in people with TTM and this may lead to intestinal problems requiring surgery. Many also chew their nails, cheek and tongue.

People with TTM are very secretive about their disorder and avoid seeking treatment. They may pull hair from places that may not be noticed to avoid drawing attention to their problem (for example, a woman with long hair might pluck from the crown and then brush the hair over to hide a bald patch). People with TTM will usually have tried stopping the behaviour themselves in a variety of ways, including taping their fingers together, or wearing hats and gloves. TTM usually begins in childhood or adolescence and there is no consistent evidence to suggest that it may be more common in males or females. Evidence suggests that several biological factors (e.g. brain structure, viral infection) may be responsible for the onset of TTM.

Environmental factors can also contribute to the onset. People with TTM often feel depressed and ashamed and have low self-esteem. Occupational, domestic and social functioning may also be affected. TTM can, however, be treated and controlled.

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