What is trichotillomania?
Trichotillomania is a medical condition in which people repeatedly pull out their hair, leading to noticeable hair-loss. Hair-pulling can affect any sites, but most frequently involves the scalp and eyebrows.
Trichotillomania is currently categorised as an ‘impulse control’ disorder according to the Diagnostic and Statistical Manual (DSM), which is used to make the diagnosis. According to the strict criteria in DSM, hair-pulling is associated with growing tension or anxiety beforehand, and relief afterwards. However, many people with hair-pulling describe their behaviour as ‘automatic’ and do not endorse these criteria.
How many people suffer from trichotillomania?
There have been no population based studies. Based on results from a study in 2500 college students, it has been estimated that trichotillomania affects 0.5-3.5% of the population at some point during life. That's a lot of people worldwide.
What causes trichotillomania?
It is likely that genes make people vulnerable to trichotillomania and related conditions. Hardly any research has been conducted. In some cases of trichotillomania, stress plays a causal role, and hair-pulling can be seen as a soothing behavior that is driven by rising tension. For others, hair-pulling is undertaken during times of relaxation and may in fact serve a self-stimulatory role, or even run automatically. My research focuses on 'neuroscience' models: we see hair-pulling as a habit that is driven by a part of the brain called the 'basal ganglia', which is quite old in terms of evolution.
Is trichotillomania the same as Obsessive Compulsive Disorder (OCD)?
Trichotillomania shares some common features with OCD, and is probably linked to common genetic factors, but it is not the same condition. Obsessions are recurrent intrusive distressing thoughts, such as the idea that a person was contaminated or that something terrible might happen. Compulsions are repetitive behaviours performed either in response to obsessional thoughts or according to rigid routines. Hair-pulling can have a ‘compulsive’ edge, but is not usually driven by obsessional thoughts, and is not typically associated with other complex or rigid rituals (e.g. door checking). Because of these confusions, it is recommended that diagnoses are made by a clinican who specialises in these areas where possible. Trichotillomania can occur as part of OCD, but most people with trichotillomania do not have OCD.
What are the treatments?
Treatments for trichotillomania can be divided into (a) psychological therapies, (b) medications, and (c) others. There have been some treatment trials conducted for trichotillomania but we have little good quality evidence to go on.The main type of therapy used to treat trichotillomania is called 'habit reversal therapy'. This involves training people to recognise when they are likely to undertake hair-pulling, and swapping the hair-pulling with another simple response that is not damaging, such as clenching fists. A variety of medications have been studied. There is some evidence that clomipramine or citalopram (serotonin selective reuptake inhibitors) can help; on the other hand, another serotonin selective reuptake inhibitor called fluoxetine was found to be ineffective in three trials. We need more good quality clinical trials before firm advice can be given. In terms of other options, support websites and reading material can be very useful - see the links below and 'books' section.
There are several excellent websites that give information and support about trichotillomania, and I have listed some main ones below:
Trichotillomania UK is run by Claire, a long-tanding trichotillomania sufferer and supporter of trichotillomania research. Her website includes information about trichotillomania and helpful resource links.
Lucinda Ellery is a London UK based consultancy providing tailored treatments for hair-loss. Dr Sarah Riley is a General Practitioner who works with Lucinda Ellery, and specialises in hair-loss.