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What is Trichotillomania?

Trichotillomania (TTM), otherwise known as Trich, is a disorder where people pull out their hair, one strand at a time, from their scalp, eyelashes, eyebrows or other parts of the body.

For many individuals who have TTM they may have noticeable bald patches or no eyelashes or eyebrows.

wheat fieldTwo types of TTM

  1. Where the person knows that they’re pulling out their hair or eye lashes.
  2. Where the person doesn’t realise that they’re pulling out hair/eye lashes until they notice the hair, eye lashes, etc beside them. This typically happens when the person is doing something else such as talking on the phone, studying or watching television.

Signs and symptoms of TTM

Not all of the below are experienced by all:

  • lnability to resist urges to pull out one’s hair
  • Increasing tension before one pulls his/her hair/eye lash/eye brow
  • Enjoyment and relaxation when pulling
  • A feeling of relief after pulling
  • Noticeable hair loss
  • lncreased upset and/or difficulties with daily life.

Both men and women are effected by TTM and it can start at any age. For many people they usually start pulling around 12 years-old. The Trichotillomania Learning Centre in America thinks about 2-4% of the population has this disorder. In other words, this means that two to four people in every 100 would have TTM, so it is more common than realised.

TTM ranges in severity for people. Some people may only pull hair from one area, but others may pull hair from a couple of areas.
From time-to-time people who have TTM will suck or run the hair through his/her teeth and occasionally there are people who eat the hair. This is called Trichophagia and in severe cases it can cause intestinal blockages that require surgery.

Problems that arise from TTM

Here are some possible problems that may arise for people who have TTM:

  • If the person pulls eye lashes/brows then they may avoid eye appointments
  • If the person pulls in the pubic region the they may avoid getting regular preventative check ups
  • If the person eats the hair it can become lodged in teeth or it can lead to problems with the stomach, digestive tract, bad breath, bowel obstruction (or even perforation) as well as issues with the liver and pancreas functions
  • Difficulty in starting and maintaining intimate relationships with a significant other due to shame, embarrassment
  • Avoidance of social functions like parties, days out with friends
  • Avoidance of job interviews or interviews for promotions
  • Avoidance of occasions where there may be a pool, amusement park rides, windy conditions or an activity whereby the hair arrangement and/or wig is impacted.

People who have TTM can be creative when trying to cover up the hair loss. For example, women may have special hair styles or get extensions. Men may decide to shave their head or wear hats a lot of the time.

What it’s not

Please remember that TTM is not:

  • just a nervous habit
  • a sign of abuse
  • a sign of emotional disturbance
  • your or your parent’s fault
  • people with TTM are not trying to hurt themselves or do this for attention.

What makes a person want to pull their hair out?

There are times when the urge to pull hair feels more intense, as when a person is:

  • stressed.
  • tired
  • hungry
  • bored.

Why would someone pull their hair out?

Nobody knows why people do this. There is research into the area, trying to figure out. In some cases there does seem to be a link with anxiety.

A number of people have said the TTM started after a stressful event in his/her life. TTM can also occur with skin picking and/or Obsessive Compulsive Disorder (OCD).

What someone with TTM might feel

Trich is often not discussed or acknowledged because of the shame and embarrassment it causes the people who have it.

Some aspects of the emotional toll TTM creates for people:

  • Feelings of shame helplessness, isolation and frustration are common
  • People report feeling that TMM has ruined their life
  • People can go for years without asking for help and keeping it a secret
  • Depression and low self-esteem are common
  • People with TMM may suffer teasing, anger and insensitivity from family members.

How to manage TTM

If you are effected by TTM here are some tips for self-management of the urge to pull, taken from www.OCDIreland.org.
These are a collection of ideas from people who have TTM on how to substitute the sensory stimulation and emotional soothing the pulling provides. Feel free to share your tips with what works for you.

Create a barrier to reduce the tactile sensation

  • Transparent micro-pore tape (available in pharmacies) – place a little bit on both thumbnails and it reduces the ability to grip short hair and it is quite discrete
  • Put a barrier cream like Vaseline on brows or target hotspots to reduce grip
  • Band aids and gloves are useful barrier tools
  • Keep barrier tools available where needed such as around your house, office, car, anywhere you are likely to pull
  • Wear gloves if you pull when driving. The thin leather gloves (like golfing gloves) are best and put them on before you get into the car each time! Remember to acknowledge your success when you arrive without pulling each time
  • Other useful barriers include hats, scarves, wigs/hair pieces/volumiser.

Alternative sensory input

Invest in some massage tools such as

  • Head massager (“the tingler” works for some, available online)
  • Hand/foot massager
  • Back scratcher
  • Give yourself a treat with a head massage and hand massage.

Toys for your hands

  • Latex stretchy toys, or plastic or wooden spikey toys (available in Euro shops, craft-shops and on-line – search for office stress toys)
  • Keep these toys in all your hot spots – places where you pull most such as where you read, watch TV, talk on the phone, etc

Things for your mouth

  • Coffee stirrers – plastic/wooded coffee stirrers have saved many a hair by offering something interesting to do with your mouth. Be careful of your teeth though!
  • Try ice chips in the mouth but be careful of your teeth. This is also good for pressing onto an inflamed or itchy spot that is drawing your hand to pull.

Reduce scalp, eyelid irritation and inflammation

If inflammation, itching or localised skin irritation is drawing your hand to pull, see your doctor, or a dermatologist. Perhaps your local chemist could advise about topical steroid soothing lotions and shampoos.

Adopt a slogan that speaks to you:
Be gentle
Let it grow
Progress, not perfection
One day at a time
Keep it simple
Just for today
It begins with me
Recovery isn’t a straight line.

When should you seek extra help?

Trichotillomania is manageable. Many people with TTM lead active and fulfilling lives.
Research has shown two types of treatment work. This is medication and/or Cognitive Behavioural Therapy (CBT). These options focus on the management of the disorder since there is no cure and there is no one proven effective treatment of TMM.

In the CBT sessions the therapist will work with you to figure out what may set off the urge to pull as well as to develop new skills to cope with the urges in a different way. By becoming more aware of your triggers, such as stress, overwhelming emotions and boredom. This will help the person develop/ learn new skills to cope with the TMM more effectively. This type of CBT is called Habit Reversal Training (HRT).

Extra support?

In Dublin, OCD Ireland provides free monthly talks on topics such as TTM. They also run a free monthly TTM support group for people over 18 year- old that meets in St. Patrick’s University Hospital. The calendar of events and other information about TTM can be found at: www.OCDIreland.org.
The Trichotillomania Learning Centre in America provides lots of resources, as well as online support, for people who have TTM. The website is: http://www.trich.org/.
Both of these organisations also have courses to help family members and friends as well.

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This article was last reviewed on 28 March 2017

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