by Bill White

Created on: April 25, 2009

Trichotillomania (TTM), what I'll call "trich," is a fascinating, albeit brutal, mind variance (my stigma-reducing term for "mental illness"). Now, if you've elected to read an article addressing treatment you more than likely have a pretty good idea as to just what trich is. But to make sure no one's left in the dark I'm going to offer some details.

The DSM-IV-TR, the book of formal psychiatric diagnoses, categorizes trichotillomania as an impulse control disorder. That would make it akin to pathological nail-biting, fire-setting, stealing, gambling, skin-picking, and explosive behavior. But some would categorize trich as an anxiety disorder, similar to obsessive-compulsive disorder (OCD). Others believe trich is a tic disorder, even an addiction. It's interesting that trichotillomania has been recognized as a "disorder" for only about twenty years.

Okay - hair is where it's at for those dealing with trich. And that means hair anywhere. The preferred sites are the scalp, eyebrows, and eyelashes. But hair on the face, nose, pubic and perirectal areas, chest, arms, and legs are fair game. At its worst, pulling behavior can become so intense and chronic that it leads to very noticeable bald spots. And in some ten percent of trich cases the pulled hair is eaten causing what's called a bezoar; a fancy medical term for, in this case, a hairball. These may require some pretty heavy medical intervention. Most often used in the act of pulling are fingers, tweezers, pins, and other creative "pullers."

A trich episode is often induced by a stressful event or mood situation. However, an episode may also emerge in the midst of calm. No matter how you slice it, the end result is an "urge." And quite often a sense of relief is realized after the urge has been acted upon. Though trich behaviors can be conscious acts, they're very frequently performed unconsciously, almost as though the individual is in a trance. In most cases, trich doesn't result in a significant compromise in mental and emotional functioning; however, the social ramifications may be severe. I mean, we're dealing with bald spots and, perhaps, wigs, funky hairstyles, and some very creative make-up schemes. Needless to say, peers and friends may run from a trich sufferer, resulting in a head full of very low self-esteem. And for the record, because of stigma and the potential for alienation cases of trich are highly under-reported.

Trich's average age of onset is between the ages of nine and fourteen and it's

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