Trichotillomania is considered to be an impulse control disorder that causes an individual to feel an uncontrollable compulsion to pull or play with their hair resulting in noticeable hair loss.  Impulse control disorders are characterized by the inability to control, or failure to resist, the temptation to perform an act that is undesirable or harmful to the individual or someone else.

Individuals with trichotillomania characteristically experience an increasing tension, arousal, or building of anxiety before pulling their hair, then experience a sense of relief, gratification, release of the tension, or some degree of pleasure as a result of the pulling.  The pulling is usually described as soothing rather than painful.  An individual often suffers from remorse, regret, self-reproach, shame, or guilt after hair pulling.  Some individuals describe the "pulling" of their hair as being more like stroking, twirling, playing with, itching, or gently tugging their hair, and will express disbelief at the thought that it could result in the hair loss they are experiencing.  An individual may pull their hair from any part of their body including their scalp, eyebrows, eyelashes, facial hair, arms, legs, neck, etc.  Many individuals report being completely unaware of their pulling behaviors.

The fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders lists five diagnostic criteria as necessary to accurately diagnose an individual as suffering from trichotillomania:

1. "Recurrent pulling out of one's hair resulting in noticeable hair loss."
2. "An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior."
3. "Pleasure, gratification, or relief when pulling out the hair."
4. "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)."
5. "The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Not all individuals who pullout their hair meet all of these strict criteria.  Nonetheless, an individual might experience distress resulting from their hair pulling and might very well benefit from treatment for trichotillomania.

Trichotillomania often begins in childhood or adolescence.  In some cases, hair pulling is temporary and may stop suddenly without explanation.  For most people, however, treatment is necessary to avoid recurrence.  The comforting aspect of the pulling may partially explain the persistence and continuance of the behavior.  Some individuals persist in the hair pulling in a rather compulsive fashion and are unaware of a pulling episode until they stop and have sustained significant hair loss.  They may describe this as being similar to a dissociative state in which the person appears to be in a mild trance.

Trichotillomania occurs with about the same frequency in girls and boys during childhood.  However, later on in life it is much more common among females than males.  Some studies have suggested that females may be affected by as much as five to ten times more.  Whether the prevalence among females reflects a true higher incidence rate for women or is more reflective of social and cultural attitudes is unclear.  It may just reflect that men feel hair loss is less socially ostracizing.

The first step in any treatment program is to rule out any medical or physiological conditions that may cause or increase the severity of hair loss.  The next step is to evaluate whether or not other psychological factors may be contributing to the hair pulling or interfere with treatment.  In most effective treatment programs both psychotherapy and medication are combined.  A behavioral technique called habit reversal is employed to establish an awareness of the pulling.  The individual then practices an incompatible behavior to replace the urge to pull.  If anxiety or stress is a major component contributing to the frequency or intensity of the hair pulling, various relaxation techniques are usually beneficial in reducing the pulling urges.  These relaxation or stress management techniques include systematic progressive relaxation exercises, yoga, self-hypnosis, and biofeedback.  Medications such as those affecting serotonin levels have been shown to reduce severity of hair pulling.  In a comprehensive treatment program the psychologist will also address issues such as the effects of the trichotillomania on social and personal functioning, one's self-esteem, and family relationships.

Persons interested in trichotillomania treatment services can contact Daniel J. Goeckner. Ph.D. Clinical Psychologist. at (262) 241-9990 or e-mail Dr. Goeckner.