What is Trichotillomania (TTM)?
TTM is a medical illness, not an uncontrollable, 'crazy' habit.
In the UK it is still relatively unheard of but it is gradually gaining greater understanding by clinicians and attracting increasing attention, particularly from the media
It is a biological and behavioral override of a persons ability to control his/her own physical behaviour.
TTM is officially classified as an impulse control disorder
According to the current psychiatric diagnostic manual (DSM-IV), the diagnosis of trichotillomania requires the following:
Recurrent pulling of one’s hair which results in noticeable hair loss.
An increasing sense of tension immediately before pulling out the hair, or when attempting to resist the behavior.
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.
TTM belongs to a group of disorders called body focussed repetitive behaviours (BFRBs)
Often, people who hair pull also experience symptoms of obsessive compulsive disorder(OCD), Body Dysmorphic disorder (BDD) , skin picking or nail biting
Pulling can be from the scalp, eyelashes, eyebrows, pubic hair or other areas
TTM affects 2-4% of the general population, that is 1 or 2 out of every 50 people
Hair pulling most commonly begins in the early teens, though it can start at a much younger or older age. It has been see in children as young as 22 months. Onset has not been see in people over the age of 60.
The onset in some cases can be linked to a stressful life event eg abuse, parents divorcing, the death of a family memebr etc but this is not always the case.
Hair pulling creates a short term distraction from other emotional distress such as anxiety, depression, aggression, dependency.
TTM Symptoms include:
A build up of tension which can only be relieved by the hair puling
A pleasurable sensation as the hair is pulled
Sometimes it is done quite consciously, other times it is an unconscious thing, the person doesn't realise they are doing it
People often describe the experience of pullling as being in a trance like state
It can be a response to overstimulation eg stress, excitement or a response to understimulation eg boredom, inactivity
Pulling brings immediate relief and comfort but later there is anxiety, frustration, embarassment and distress There is a need to find the right hair to pull - it may be one that feels different, perhaps thicker than the others, curly or a different shade or colour
Once the hair has been pulled it is often played with, rubbed between fingers, the hair bulb separated, the hair run between the lips or eaten
The impact of TTM on peoles lives is huge. It includes felings of shame, solation, low selfconfidence, depression, difficulty in having close, intimate relationships, not being able to participate in cerain activities liekswiming, going to the hairdressers, not being able to do a certain kind of job because wearing a hat would be inappropriate.
These pictures represent an example of hair loss casued by Trich. Patterns of pulling can take many forms. You may find this does not represent your pulling at all. That is ok. It is just one example. Some people will pull from specific areas eg behind the ears or from the crown. In this instance the hair is kept very short to try and reduce the amount of hair pulling. Some people with long hair are able to cover up the patches and they are not really noticeable.
These photographs are not to be reproduced without permission.