An overview on trichotillomania and the need to pluck hair

Trichotillomania (TTM), also known as hair-pulling disorder, is a condition that compels people to pull out their hair. This behavior can result in significant hair loss and emotional distress, often leading to social avoidance and attempts to hide the issue with hats, wigs, and hairstyles to cover affected areas of scalp​.

The term ‘trichotillomania’ was first coined in the later part of the 18th century, and the condition was originally described in ancient Greece according to medical textbooks from the period. Studies indicate that the lifetime prevalence of TTM is reported as high as 3.5%​. It affects 1-2% of all adults and adolescents. While both boys and girls may experience trichotillomania in childhood, the adult manifestation of the disorder predominantly affects women.

Individuals with trichotillomania often unconsciously pull their hair and may be unaware of their behavior until presented with physical evidence. Sometimes it can involve video footage of the hair plucking event, often taken by friends and family members, before the individual realizes and accepts that they have trichotillomania. The disorder can affect both children and adults, and most commonly it first emerges around the age of 13. In childhood, both males and females are similarly affected, but in adulthood, it is mostly females that are affected.

People with trichotillomania may pull hair from any part of their body, although the most common areas are the scalp, eyebrows, and eyelids. The intensity varies from person to person, with some pulling out handfuls of hair and others targeting one strand at a time. Around 20% of individuals eat their hair after pulling it out, a behavior known as trichophagia, which can lead to gastrointestinal hairballs that can require surgical intervention​​.

Trichotillomania is considered a neurobiological condition, often developing in individuals with anxiety disorders or mood problems. Interestingly, it’s not exclusive to humans. Animals, including mice and parrots, have been observed to exhibit similar hair-pulling behaviors under stressful conditions, a behavior known in mice as ‘barbering’. Certain mouse strains are more prone to barbering than others, suggesting a genetic component to this condition.

The treatment approaches for trichotillomania vary, often depending on whether a psychiatrist or dermatologist is providing the care. Psychiatrists tend to focus on the psychological aspects of the disorder, exploring potential underlying issues that may have led to the development of the hair-pulling habit. Therapy and medication are common treatment options. Dermatologists, on the other hand, offer more direct interventions aimed at inhibiting the physical act of hair pulling. For example, they may recommend that a child wear gloves to prevent tactile identification of hairs to pull, or they may suggest applying vaseline to the hair to make it difficult to grasp.

The prognosis for children with trichotillomania is generally positive, with many outgrowing the condition with appropriate treatment. However, it’s crucial to seek successful treatment early on because continuous hair pulling over several years can lead to permanent damage to the hair follicles. This can result in hair not growing back properly or at all, a condition known as traumatic or traction alopecia. Unfortunately, adults who develop trichotillomania typically have a poorer prognosis and are less likely to respond to treatment.

In conclusion, trichotillomania is a complex disorder with multifaceted implications. It is not merely an issue of cosmetic concern, but a mental health disorder that can significantly affect a person’s quality of life. Despite its prevalence, it is often misunderstood or misdiagnosed, which can delay the administration of appropriate treatment. Increased awareness, understanding, and research are essential for improved diagnosis, treatment, and support for those living with trichotillomania. With the right approach, we can hope to significantly improve the prognosis for those affected and ultimately reduce the prevalence of this challenging condition.

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