One Must Understand Trichotillomania Before Trying to Treat It




This hair loss condition is very often confusing to friends and family members of those who suffer from TTM. Understanding trichotillomania can go a long way in helping to treat it.

Q. How is this disease’s name pronounced?

Trichotillomania is pronounced trik’oh-till’oh-may’nee-ah. People call it “trich” or TTM, for short.

Q. What’s the difference between bald spots caused by trichotillomania and those caused by another disease, such as alopecia areata?

A dermatologist is trained to feel for TTM and will suspect this disease if there is stubble in the bald spots, which suggests that hair is growing back because it was removed. The bald patches of alopecia areata patients feel smooth, as do pattern baldness spots, because hair is not growing back. A doctor will verify the disease by examining any bald patches through a scope to confirm hair growth.

Q. Why would anyone get into the habit of pulling out his or her own hair?

Trich is a strong compulsion to pull out hairs and can affect any head, facial or body hair, resulting in noticeable bald patches and serious hair loss in severe cases. This need to pull out hair is so strong that it goes far beyond a habit.

Q. How does someone “get” trichotillomania?

Researchers are unsure how the compulsion starts, and they have found that trich can strike happy, well-adjusted people as often as emotionally disturbed or depressed people. It is an emotional disease and a compulsion, so it cannot be “caught” or spread among people. Usually the disease starts in early adolescence, with the typical first-time hair puller being around the age of 12. Many experts now think the disease is caused by an imbalance of brain chemicals.

Q. Does trichotillomania affect men or women, or both?

The hair-pulling behavior affects approximately 1 in 50 people, and 90 percent of those with TTM are women, according to current statistics on the disease from the Trichotillomania Learning Center (TLC). Some experts think this is because symptoms are less noticeable in men with short hair and/or male pattern baldness. Men are also less likely to seek medical attention, so statistics may be skewed.

Q. Who can diagnose Trichotillomania?

A dermatologist is most often the doctor who will uncover secret hair pulling once hair loss or a skin or scalp rash from the pulling becomes a symptom. In addition, if the individual is referred to a mental health counselor, that person can confirm the emotional aspect of the disease. A hair replacement specialist will be able to help with a solution for hair pulling and subsequent hair loss, such as a wig.

Q. Can hair pulling be controlled?

In some patients, hair pulling is a strong compulsion and is unavoidable, but others can learn to control urges through willpower and awareness. Trich does not affect everybody to the same degree; in addition, some people pull scalp hair, others pull facial or body hair, and still others pull any and all hair.

Q. What are the current treatments for Trichotillomania?

Although no treatment is effective for everyone, a number of treatment options have shown promise. Prescription medications and cognitive-behavioral therapy are the most successful options, although children and adolescents, in particular, have needs that are different from those of adults. Patients and doctors may need to experiment with varying combinations of treatments, medications and tools to find what works best on an individual basis.

Q. Are there alternative treatments to help reduce hair pulling?

Experts have found that depression is a contributing factor to the illness, so medication for depression symptoms can be helpful. In addition to medical treatment, many patients find relief through dietary changes, meditation, hypnosis, prayer, yoga and herbal remedies.

Q. Will hair that has been pulled out grow back?

In extreme cases of prolonged and severe hair pulling, hair loss can become permanent. In milder cases hair keeps regrowing, although facial hair such as eyelashes and eyebrows notoriously takes longer to grow back. A dermatologist can confirm hair follicle health and offer a prognosis for hair regrowth.
The best way to cover or hide bald patches is to solicit the help of a non-surgical hair replacement specialist. These experts can suggest a solution that covers just the bald patches, seamlessly, or they can provide for whole-head protection with a natural-looking, full-head wig. Sometimes, wearing a hair replacement can reduce the urge to pull and can help patients to feel and look better, but some patients have been known to pull even hair replacements. Check out the Trichotillomania Learning Center at for support groups, to help find a practitioner and to learn more about research on and treatments for TTM.