Trichotillomania

Trichotillomania

What is Trichotillomania? The official diagnostic criteria are:

  • Recurrent pulling out of one’s hair resulting 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 causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

However, these criteria do not seem to apply in all cases. Many people who have TTM do not have the tension/relief cycle described in these diagnostic criteria. Probably the best definition is simply chronic and repetitive hair pulling. Hair is usually pulled from the eye brows, eye lashes or the scalp, but can be pulled from any location on the body where hair grows (genitals, under arms, etc.).

How common is Trichotillomania?

There have been as of yet no large scale epidemiological studies of TTM, so it is difficult to obtain an accurate estimate of the prevalence of TTM. One study done in 1991 using the official diagnostic criteria noted above, estimated a lifetime prevalence rate for TTM of 0.6% for both male and female college freshmen. Once they expanded their definition to “chronic and repetitive hair pulling” and eliminated the requirement for the tension/relief cycle, the lifetime prevalence rose to 2.5% for both sexes combined (3.4% of females and 1.5% of males). Using the more realistic figure of 2.5%, the rate of occurrence of TTM is about the same as that for OCD.

The above figures would seem to suggest that TTM is more frequent in women than in men, yet that may not be the case. Men can more easily hide bald spots by shaving their beards and/or heads. Women often have more of their self-esteem wrapped up in their looks than do men and so may be more apt to be more distressed by their pulling and thus more likely to see pulling as a problem.

What causes Trichotillomania? How does it start?

We don’t really know the answer to this question. Some people report that they have pulled for as long as they can recall while others clearly recall a specific time, even moment, when their pulling actually started. Often people report a major change or a particular life stressor seemed to precede the onset of their TTM. More research is needed to adequately answer this question.

How is Trichotillomania treated?

There is no one “gold standard” treatment for TTM. The usual method I use involves first of all keeping a detailed diary of the pulling and trying to understand in as much detail as possible the what, when, where, how and why of pulling and then using this information to custom design interventions based upon this information. Most experts believe the purpose of the pulling is some sort of nervous system regulation. Somehow the pulling helps TTM sufferers regulate their nervous systems in somewhat the same way most of us use a cup of coffee or going for a jog.

We highly recommend the book below about Trichotillomania.

Trichotillomania: An ACT-enhanced Behavior Therapy Approach

Trichotillomania: An ACT-enhanced Behavior Therapy Approach

Douglas W. Woods & Michael P. Twohig

This manual was written as a tool for therapists to become familiar with an effective treatment for TTM. The treatment approach described in this guide blends traditional behavior therapy elements of habit reversal training and stimulus control techniques with the more contemporary behavioral elements of Acceptance and Commitment Therapy (ACT). Unlike traditional interventions that aim to change type or frequency of pulling-related cognitions in the hopes of reducing urges to pull hair, this innovative program uses strategies to change the function of these cognitions.

Click here for more excellent books about Trichotillomania.

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