Psychological Conditions

Trichotillomania (TTM)

Trichotillomania (TTM) is an impulse control disorder that involves strong, irrepressible urges to pull out hair from one’s own scalp, eyebrows, eyelashes, or other areas of the body. Despite this traditional classification, TTM is also commonly regarded as an “Obsessive-Compulsive Spectrum Disorder” because of professed similarities to a tic disorder or obsessive-compulsive disorder. Typically, the inability to resist hair pulling results in significant hair loss, causing bald patches in the affected areas of the body and often great emotional distress.

TTM affects approximately one to two percent of Americans, mostly in pre- or early adolescence, and the majority of TTM sufferers are women. The disorder, however, may affect people of all ages, of either sex, in different ways. The severity of symptoms, for example, differs greatly by case. Mild symptoms may be easily extinguished through small improvements in awareness and concentration while severe symptoms, which consist of pervasive, completely thought-consuming urges to pull hair, require more intensive treatment. The emotional impact of TTM also varies by individual and may include feelings of depression and shame. In fact, a person with TTM will usually feel very embarrassed about the bald patches on their body and will go to great lengths to cover them up with different hairstyles, clothing, and make-up.

There are several different treatment options for TTM, though the effectiveness of each varies on an individual basis. Treatments include:

Cognitive-Behavioral Therapy (CBT) is a form of therapy that seeks to alter behavior by identifying the precise factors that trigger hair pulling and learning skills to interrupt and redirect responses to those triggers. Cognitive-behavioral should be performed by a clinician trained in this method and well versed in trichotillomania – something that may be easier said than done, as there is not an abundance of professionals with this specialty. The therapist will encourage hair pullers to develop an increased awareness of the times of day, emotional states, and other factors that promote hair pulling, as an important element in being able to control the behavior. Some hair pullers have had success with simple behavioral devices such as putting bandages on their fingers to interfere with pulling, keeping records of their hair pulling, or changing environmental cues that can trigger pulling.

One specific type of CBT is called Habit Reversal Therapy (HRT). HRT is a specific behavioral strategy that includes four stages: Recognize, Resist, Release, and Reward. Recognize- attempts to bring to awareness a person’s ability to recognize their urges to pull their hair. Resist- attempts to fight the urge to pull your hair with straining another muscle group. Release- is when the urge has been fought and has passed. Reward- is using a tangible or intangible reward after the urge has been fought and you were successful at resisting.

The treatment of TTM with medication has had mixed results. Selective serotonin-reuptake inhibitors (SSRIs), such as Lexapro and Zoloft, have shown promise, but, while a small percentage of people do find relief from hair pulling urges, some experience only limited benefits or none at all. Current research is exploring the possible advantage of combining medication with cognitive-behavioral therapy.

Coping with a TTM is often a lonely and difficult process because of the shame associated with any such disorder. Thus, many TTM sufferers benefit from sharing their experience with others. Participating in support groups lessens the feeling of embarrassment and isolation and helps those afflicted with TTM to focus on treating their hair pulling urges.

Tip: Daily recognition of when you have urges to pull your hair is a good step to starting to fight. You can use a log to keep track of times and dates.