Trichotillomania

What is trichotillomania?

Trichotillomania (also called "trich" or "TTM") is when someone can't resist the urge to pull out their hair. This might be hair from their head, eyebrows, eyelashes, or other parts of the body.

This condition usually starts when someone is between 10 and 13 years old. It's not something people choose to do - it's a genuine medical condition that needs understanding and support.

What does it feel like?

People with trich describe feeling a strong urge to pull their hair out. This urge builds up tension until they actually pull the hair, which then brings a sense of relief.

Sometimes hair pulling happens in stressful situations. Other times, people do it without really thinking about it - almost automatically.

The pulling usually creates bald patches on the head that might have unusual shapes. Often, one side of the head is more affected than the other.

How does it affect people?

Trich can cause feelings of shame and low self-worth. Many people try to hide their condition from others, which can make them feel isolated and anxious.

The visible hair loss can affect how someone feels about their appearance and their confidence in social situations.

What causes trichotillomania?

Doctors aren't completely sure what causes trich, but it might be:

• A way of dealing with stress or worry
• Related to chemical changes in the brain
• Connected to hormone changes during puberty
• Something that runs in families

For some people, it becomes a habit that's hard to break. The more they pull their hair, the stronger the urge becomes.

When to speak to your GP

You should speak to your GP if:

• You're pulling your hair out and can't stop
• You notice your child is pulling their hair out
• You or your child eats the hair after pulling it out (this can cause serious health problems)

Your GP will examine the areas where hair is missing to check nothing else is causing the hair loss, like a skin infection.

How is it treated?

The main treatment is a type of talking therapy called cognitive behavioural therapy (CBT). Specifically, something called "habit reversal training" helps replace hair pulling with safer actions.

Treatment usually includes:

• Keeping a diary of when you pull your hair
• Learning what triggers the urge to pull
• Finding other things to do instead, like squeezing a stress ball
• Getting support from family and friends

Things you can try yourself

Many people with trich find these helpful when they feel the urge to pull:

• Squeeze a stress ball or stress toy
• Make a tight fist and tense your arm muscles
• Use a fidget toy
• Wear a bandana or tight hat
• Take a relaxing bath
• Practice slow, deep breathing
• Do some exercise
• Put plasters on your fingertips
• Cut your hair short

Getting support

Talking to people you trust about trich can help reduce anxiety and the urge to pull. Many people find that being open about their condition actually helps them manage it better.

Remember, trichotillomania is a real medical condition - not a choice or a habit you should feel ashamed about. With the right support and treatment, it can be managed successfully.

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Based on NHS.uk guidance. Written by Dr Krishnan Pasupathi, NHS GP.