Trichotillomania

Trichotillomania (TTM) is a mental health condition in which people pull out their hair one strand at a time over an extended period. People with TTM experience an overwhelming urge to carry out this compulsion, even when they don’t want to. Living with TTM can be very stressful because people go to extreme lengths to hide their behavior and hair loss to avoid embarrassment, negative judgment and shame.

TTM is usually experienced for many years and often leads to depression, low self-esteem, and social isolation. 

Prevalence 

Approximately 1-3% of the population lives with TTM. Based on the lower end estimate (i.e. 1%), 231,300 individuals in Australia currently have TTM. It usually begins during puberty, and lasts an average of 20 years, although earlier onset in infancy and childhood is possible. Women generally seem more affected than men, and report more severe and distressing experiences.

People with TTM sometimes also report skin-picking or nail-biting behaviours, and can have other mental health conditions, such as depression or anxiety.  

Possible causes

There are many factors which contribute to TTM. Genetics can play a part, with family members more likely to experience TTM or similar disorders, such as obsessive-compulsive disorder (OCD). Psychological factors, such as thoughts, managing feelings and perceived control over behaviors, can also contribute to symptoms of the disorder. Avoidance of emotions, positive and negative, has recently been proposed as an important underlying issue.

Negative social responses to hair loss, as well as cultural expectations about beauty can act as further influences.

Symptoms

Its main feature is the repeated pulling out of hair, regardless of multiple attempts to stop the behavior. This causes distress and interferes with important areas of life, such as relationships, work and well-being. 

Treatment options

The most effective treatment for TTM is behaviorally-based psychological therapies, which typically up to 15 sessions spread over 10 weeks. Types of therapy are habit reversal therapy (HRT), cognitivebehavioural therapy (CBT), or acceptance and commitment therapy (ACT) with added behavioural components. In Australia, treatment providers and support groups can be found by contacting the Anxiety Recovery Centre Victoria (ARCVic).

There are also a number of online support groups.