A number of celebrities, including Amy Schumer, have spoken out recently about their struggles with trichotillomania – or trich, as it is often called for short – sparking a wave of interest in this poorly understood condition. Also known as hair pulling disorder, trich involves the repetitive plucking of hair from one’s scalp, face or body, and can cause sufferers considerable distress.

How Does Trichotillomania Manifest?

Along with nail-biting and excoriation (skin-picking) disorder, trichotillomania is among the most common of the so-called body-focused repetitive behaviors (BFRBs). These compulsive self-grooming behaviors typically begin in childhood and are equally common in boys and girls, although women account for around 80 to 90 percent of adult trichotillomania cases.

For many people with the condition, hair pulling occurs automatically and unconsciously while engaging in other activities like watching movies or reading. In other instances, the behavior is more intentional, and sometimes involves the deliberate use of tweezers to pluck hairs while standing in front of a mirror.

Hair pulling can be triggered by a wide range of stimuli, including stress, anxiety, boredom or physical sensations like itching or pain. While some sufferers focus mainly on their head hair, others may target their eyebrows, eyelashes or body hair.

In most cases, trichotillomania manifests as a chronic condition that persists for many years, though people can go through phases of more or less intensive hair pulling. Often, the consequences can be devastating, leaving sufferers feeling isolated and ashamed due to their appearance and a general lack of understanding about their condition.

What Causes Trichotillomania?

Contrary to what some people may believe, trichotillomania is unlikely to be caused by unresolved trauma and is not considered a form of deliberate self-harm. Nor is it a form of obsessive-compulsive disorder (OCD), as evidenced by the fact that OCD medications don’t seem to be effective for the treatment of trich.

Having said that, it is classed under “Obsessive-Compulsive and Related Disorders” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the recognized classification model for psychiatric conditions. Exactly how BFRBs differ from OCD, however, is something that scientists are still trying to figure out.

Unfortunately, research on this subject still has a long way to go, and the likelihood is that trichotillomania arises from the complex interaction of numerous genetic and environmental factors. Back in 2006, researchers found that about 5 percent of cases can be attributed to a mutation in a gene called SLITKR1, which is involved in the formation of neuronal connections.

Further studies have shown that trichotillomania is more likely to co-occur in identical than non-identical twins, providing more evidence for a genetic component. However, the full range of factors that contribute to the disorder has yet to be ascertained.

Are There Any Treatments For Trichotillomania?

At present, there are no FDA-approved medications or therapies for trichotillomania, although some treatments have shown promise. Drugs that target the neurotransmitters serotonin, dopamine and glutamate have all been trialed as potential remedies, and while anti-depressants like selective serotonin reuptake inhibitors (SSRI) have shown limited utility, others may hold potential.

For example, an amino acid called N-acetylcisteine, which helps to modulate glutamate, has been used to effectively treat trichotillomania in some individuals. In a 2009 study involving 50 people with the condition, 56 percent showed a significant reduction in hair pulling after 12 weeks of daily treatment with N-acetylcisteine.

On the whole, though, a type of cognitive behavioral therapy (CBT) called habit reversal training (HRT) appears to be the most effective of the currently available treatments for trichotillomania. This approach is designed to help people identify the triggers for their hair-pulling and learn to replace the habit with another activity such as squeezing a stress ball.

The effectiveness of HRT is often enhanced when family and friends are included as an emotional support network, providing opportunities for loved ones to give positive feedback when hair pulling is avoided or to help sufferers became aware of potential triggers in their environment.

Sadly, however, many people with trichotillomania feel too ashamed or misunderstood to seek treatment in the first place, which is why it’s so important to raise awareness about the condition.

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