From the time I wake up in the morning till I go to sleep at night, my hand is intermittently stuck to my head like a magnet.
My index finger and thumb busily work as they probe and probe till they single out the particular kinky hair I am hunting. I run my forefinger and thumb repeatedly along the coarse ridges of the hapless strand. With an irresistible compulsion I yank it from its follicle. Rather than causing me to wince, the slight stinging of my scalp actually gives me a pleasurable sensation.
I place the hair before me like a prized trophy and proudly examine it. Automatically my hand goes back for another and yet another till I have a small pile displayed on white paper. (Now that I'm graying, I display them on black paper.) I was so relieved when I one day discovered that this quirky behavior had a name - Trichotillomania (TTM).
What is Trichotillomania?
While this behavior might seem peculiar and risible, this condition is indeed a serious psychiatric disorder. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defines TTM as follows:
- Recurrent pulling of one's hair resulting in noticeable hair loss.
- An increasing sense of tension immediately before pulling out of the hair or when attempting to resist the behaviour.
- Pleasure, gratification, or relief when pulling out the hair.
- The disturbance is not better accounted for by another mental disorder, and is not due to a general medical condition (e.g. a dermatological condition).
- The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Dr. Gary Gaffrey of the University of Iowa College of Medicine states that associated features of TTM may also include the patient examining the hair root, twirling it off, pulling the strand between the teeth or trichophagio (ingesting hairs).
The term trichotillomania derives its name from the Greek - Tricho - (thrix - hair) - Tillo - (tillein - to pull) - Mania (madness or frenzy) coined by a French dermatologist who used it in the late 1800s to label his patients' compulsive hair pulling behaviour. The name is not pertinent to the disorder because most people with TTM are not psychotic. The majority function perfectly normally and can mask their “secret” very well.
Who Gets It?
Studies show that TTM, previously believed to be rare and benign, is no longer an uncommon disorder. According to the TTM Learning Center in California an estimated 4 percent of Americans (approximately 11 million) suffer from TTM. This complaint is most common in adolescents and more common in women than men.
What Are The Causes?
The TTM Learning Center categorizes trichotillomania as an Impulsive Control Disorder - a condition whereby the patient experiences an overwhelming urge to perform an action followed by a sense of relief or gratification. The initial impulse can be triggered by various emotional cues, such as anxiety, depression, anger and insecurity. One study found “unsatisfying family relationships or loss of maternal love” in children, among the causes of TTM.
What Body Hairs Are Pulled?
Although the scalp is the most common place, no bodily hair is sacred. Eyelash, eyebrow, pubic, beard, moustache, arm, leg, chest and abdominal hairs are all targets. To most this may sound like torture. The TTM Learning Center reports that although TTM may cause disfiguration and trauma to the effected area, on the whole, patients feel little or no pain. However, chronic TTM sufferers who ingest their hair may experience abdominal discomfort, loss of appetite or bowel related problems.
Treatment
A 1993 article titled Long-term Treatment of Trichotillomania (Hair Pulling) in the New England Journal of Medicine reports the success of the drug clomipramine carried out in a double-blind test on severe-case patients. In treatments reported by other researchers drugs such as Prozac, Zoloft, Celexa and BuSpar have also been found to alleviate hair pulling in TTM sufferers. Clinicians caution that while these drugs do not cure TTM, they have been effective in reducing the urge in patients to pull out their hair. Psychotherapy, hypnosis and behaviour modification, have also proved successful.
For me, just knowing the reason for my bizarre behaviour removes the element of stress, embarrassment and frustration about it. My hair pulling episodes occur in cycles - usually triggered by anxiety or depression. It's interesting to note that TTM runs in my family. Two of my sisters have it. My one sister has it so severely that she has developed a sizable bald spot on the back of her head that had begun to affect her life.
“I realized the seriousness of it when friends gasped when they saw it. I felt very self-conscious, especially when the wind blew and exposed it. In church I sat in the back pew so that others wouldn't see it,” she said. When it comes to the cause of this condition in my siblings and I, we fit well into the study on unsatisfactory familial relationships.
Support Groups
The attention given to TTM over the past decade has spawned support groups worldwide. They can be visited at the following websites:
