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- Trichotillomania (TTM) is a hair-pulling disorder characterized by self-induced, repeated and often noticeable hair loss. It can become severe and difficult to control.
- TTM has been conceptualized as an anxiety disorder and as a disorder of habits. It is now classified as an impulse control disorder because many individuals experience a sense of relief or gratification once the hair is pulled.
- TTM causes uncontrollable hair pulling from anywhere on the body, although the scalp is the most common area followed by the eyelashes, eyebrows, pubic/perirectal area, axilla, and face. It usually results in variable degrees of alopecia.
- TTM usually presents in childhood or early adolescence.
- Denial and hiding of hair pulling is common.
- Recurrence or worsened hair pulling is associated with increased stress/anxiety, but trichotillomania can also occur at times of relaxation and distraction, such as when reading.
- The 3 subtypes of trichotillomania: Early onset, automatic, and focused (1).
- When TTM is associated with trichophagia, it may also result in GI complaints secondary to bezoars.
- TTM has frequent comorbidity with other psychiatric diagnoses.
- It is difficult to assess the exact number of individuals affected by trichotillomania because of the social stigma associated with it. Small studies have estimated a range of 1–3.5% for late adolescents and young adults (2).
- It is possible that up to 1 of 50 individuals are affected by TTM at least once in their lifetime.
- The mean age of onset is at 13 years.
- During childhood, males and females are equally affected by TTM. During adulthood, females are far more affected than males.
- Positive family history
- Other psychiatric disorders: Depression, obsessive–compulsive disorder (OCD), anxiety, posttraumatic stress disorder (PTSD), eating disorders, nail biting, skin picking
Genetics appears to contribute to the development of TTM as demonstrated by a higher rate of concordance in monozygotic twins (38.1%) vs. dizygotic twins (0%) (3).
- Serotonin deficiency
- Tension relief
- Habitual behavior
- There is currently a significant flux in the conceptualizations of the mechanisms and causes of impulse control, behavior, anxiety, and OCDs. Brain imaging, and biochemical and neuropsychological studies should help to resolve this issue. It can be expected that there will be increased differentiation as well as redefinitions of disorders that are based on neurophysiology and brain circuitry.
Commonly Associated Conditions
- Impulse control disorder
- Eating disorders