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Trichotillomania (TTM), also known as hair-pulling disorder, is a type of obsessive-compulsive disorder in which a person has a strong urge or obsession to pull out their own hair repeatedly, either from the scalp, eyebrows or anywhere on the body, leading to hair loss or functional impairment. 
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According to the American Psychiatric Association, obsessive-compulsive disorder is a type of anxiety disorder in which a person has recurring or unwanted thoughts (obsessions) that make them engage in repetitive behaviours (compulsion), mainly to get a sense of relief or to relieve their anxieties.
The condition is not life-threatening but as it is related to loss of hair, it may greatly affect the appearance of the person and may lower their confidence or cause other appearance-related social stigmas.
This article will take you to the details of trichotillomania such as its symptoms, diagnosis and treatments. Take a look.
Causes Of Trichotillomania
The exact cause of TTM is still unknown, however, stress and anxiety are considered to be the main causes of the condition. Stressful conditions and chronic anxieties may urge people to pull their own hair to get relief or deal with negative emotions. This behaviour leads to obsession or say becomes a learned habit of the patients in which they start pulling their own hair in a repeated way whenever they feel stressed out.
The cause of stress and anxieties could be related to genetic anomalies, dysfunction of the brain neurotransmitters, dysfunction in brain structures and OCD-related disorders.
- Dysfunction in brain structures: A study has shown that reduced cerebellar volumes and thickening of the right inferior frontal gyrus (brain part involved with cognition, attention, imagery and speech) can be some of the problems related to the brain structures which may lead to TTM. 
- Genetic anomalies: A study talks about TTM in three generations of families. It says that TTM is linked to rare variations in the SLITRK1 gene, which may trigger OCD in individuals, followed by TTM. Mutations in Hoxb8 and Sapap3 genes may also cause TTM-like behaviours. However, the genetics of TTM is a complex subject and needs more research. 
- Grey matter changes: Another study talks about structural grey matter changes in the brain in patients with TTM. It says that patients with TTM are often diagnosed with an increase in grey matter densities in the left striatum of the brain and multiple cortical regions. 
- Dysfunction of the brain neurotransmitters: Some studies say that changes in the neurotransmitters such as dopamine, serotonin and GABA can also lead to TTM. These three brain chemicals are highly involved in a person's mental health condition and changes in them may lead to problems like OCD, phobia or posttraumatic stress disorder (PTSD), which in turn, can lead to TTM. 
- Other: It includes boredom, negative emotions, depressive symptoms use of illicit drugs or use of tobacco products.
- Strong urge to pull hair out, mainly from the scalp.
- Sometimes pulling hair unconsciously and realise it later after seeing hair on the floor or desk. 
- Strong urge to pull hair after touching them
- Tension when trying to resist pulling the hair.
- Pulling hair continuously for one or two hours.
- Pulling hair until it feels "right" or gets a sense of relief.
- Sometimes, swallowing hair that had fallen after the pulling.
- Sense of relief or accomplishment after pulling hair, immediately followed by a sense of embarrassment.
- Age: TTM usually starts at the age of 10-13 years. However, experts say that there is no age limit for TTM as it may also start by the age of four or after the 30s. 
- Gender: Most of the people diagnosed with TTM are females compared to males.
- Family history: People who have a family history of OCD or TTM are more likely to get affected by the condition.
- Stress: Severe stressful conditions can trigger TTM in people, even in those without any genetic anomalies.
Note: Experts say that TTM is mainly triggered by the combination of the aforementioned factors.
Symptoms Of Trichotillomania
Risk Factors Of Trichotillomania
Some of the risk factors for TTM include:
Complications Of Trichotillomania
If left untreated for longer, TTM can cause complications such as:
- Permanent hair loss
- Trichobezoar, a condition characterised by a mass of hair in the gastrointestinal system leading to severe stomach issues.
- Alopecia, a type of hair loss condition.
- Very low quality of life
- Skin damage of pulling is done by scissors.
- Appearance-related problems.
Diagnosis Of Trichotillomania
Experts say that seeking the diagnosis of the condition is uncommon as people with TTM often think that a medical expert or doctor may not be able to understand their disorder. Other reasons may include shame, lack of awareness or fear of professional reactions.
TTM is mainly diagnosed by looking at the signs such as loss of hair. A medical expert may proceed with questions to understand whether the condition is genetic, related to OCD or other factors like the use of illicit drugs.
Some behaviours like repetitive mail biting or picking skin are also observed by medical experts for diagnosing the condition.
If the physical symptoms and behaviours confirm TTM, a medical expert may also suggest neuroimaging.
Treatments Of Trichotillomania
Some of the treatment methods for TTM include:
- Medications: It includes medications such as Selective serotonin reuptake inhibitors (SSRIs) to treat underlying anxieties and negative emotions.
- Habit reversal training: It includes teaching the patients and how to control their urge to pull hair.
- Stimulus control: It includes teaching the patient some ways in which they can keep their hands away from their head to prevent triggering of the urge.
TTM can be reversed completely if a patient is well understood by a medical expert and given treatment accordingly. It includes understanding the triggering factor or reasons for anxieties and teaching them how to deal with them.
Early diagnosis and treatments of TTM can help minimise the risk of severity related to the condition. Consult a medical expert if you have TTM or know someone with the condition.
Yes, trichotillomania comes under obsessive-compulsive disorder which is a type of anxiety disorder characterised by recurring or unwanted thoughts (obsessions) followed by engaging in repetitive behaviours (compulsion), mainly to get a sense of relief or relieve their anxieties.
Yes, trichotillomania can go away with patient-centralised treatments, either with medications or behavioural therapies that include making the patient understand the condition and how they can control their urge to pull hair. A combination of medications such as SSRIs and behavioural therapies can provide better results.
The exact cause of trichotillomania is still unknown, however, studies do say that stress and anxieties are the main cause of the condition. Certain genetic, environmental and physical conditions may develop anxieties in individuals and lead them to trichotillomania, a disorder in which a person has a strong urge to pull their own hair.