Trichotillomania is a serious illness affecting many people worldwide. Similar to other obsessive habits like food addiction and gambling, persons with trichotillomania struggle with self-control, frequently pulling their hair out unintentionally.

Although the causes of trichotillomania are still unknown, experts believe it is a unison of multiple reasons.

Trichotillomania is a hair-pulling disorder that manifests as an uncontrollable need to remove one's own hair from various parts of the body. For example, individuals with trichotillomania may pull hairs from their eyebrows, scalp, or eyelashes. Also, patients might pull hairs from the pubic area, chest, limb, and underarm.

Patients with this sort of impulse control disorder may experience stress, worry, and a strong urge to pull their hair, followed by feelings of relief. Although patients' persistent twisting, tugging, and twirling of their hair may be considered typical activity, trichotillomania is characterised by observable hair loss.

A few of the symptoms of trichotillomania include the following –

• Continuous pulling of hair
• Trichophagy
• Breaking hair into pieces
• Feeling satisfaction after removing hair

Besides, individuals can also witness a few side effects, including –

• Tingling or itching on hair-pulling location
• Thinning of hair
• Bald spots on scalps
• Social anxiety
• Skin irritations

Although medical professionals are still finding the exact cause behind the causes of hair pulling, a few of the possible ones include –

• Obsessive-compulsive patients frequently develop trichotillomania.
• There may be a genetic predisposition to trichotillomania.
• It might emerge as a stress- or anxiety-related coping technique.
• There could be neurological factors responsible for it.
• It frequently co-occurs with other repeated behaviours that are body-focused, such as lip biting, cheek chewing, skin picking, acne excorié, and nail-biting (onychophagia).
• A lack of serotonin can also trigger trichotillomania.

Children, teenagers, and grown-ups of all sexes can develop trichotillomania. Regardless, a few examples of risk factors for developing trichotillomania are as follows -

• Having a mental illness, such as sadness, anxiety, or OCD.
• Being a female (Females are four times more likely to suffer from Trichotillomania).
• Going through negative emotions such as stress, tension, anxiety, boredom, loneliness, anger, or uncertainty.

It's critical to rule out alternative hair loss reasons, particularly alopecia areata. Regardless, a dermatological evaluation could consist of the following-

Test for Hair Pull

• To rule out a fungus infection, use wood lighting

Findings From Trichoscopy and Dermatoscopy

• Fewer hairs on the head
  
• Talc for hair
• Trichoptilosis
• Snarled hairs of varying lengths
• A few short vellus hairs

Results of the Biopsy and Histology

• Thinning hairs
• Split hair shafts
• Dermis that is largely non-inflammatory
• Debris-filled plugging of dilated follicles (keratin and melanin casts)

Trichotillomania or TTM is a complicated disorder; therefore, treatment might not produce quick outcomes. However, therapy, medication and lifestyle changes can effectively treat it. Still, it might take time.

1. Therapy

The most often utilised psychotherapy treatments for trichotillomania are dialectical behavioural therapy (DBT), acceptance and commitment therapy (ACT), and habit reversal therapy (HRT).

Although each of these therapies has advantages, HRT is the most researched and effective TTM treatment.

• Habit Reversal Therapy: To reduce the symptoms of trichotillomania, HRT uses a cognitive behavioural therapy (CBT) approach that focuses on the relationship between a person's ideas, feelings, and behaviours. The four elements of an effective HRT are self-monitoring, awareness training, competing for response training, and stimulus control procedures.
• Acceptance & Commitment Therapy: ACT provides a balance between acceptance and awareness to acknowledge the way things are while drawing attention to opportunities to bring about change. Additionally, symptoms might go away if you accept your strong desire to pull and decide to adjust your behaviour.
• Dialectical Behavioural Therapy: Dialectical behavioural therapy, or DBT, works by combining the basics of CBT and a few pointers from eastern medication. Most importantly, DBT aims to teach interpersonal communication skills, emotional regulation, mindfulness and relaxation, and distress tolerance.

2. Medication

Although no medications are currently licensed to cure TTM, doctors may recommend antidepressants. This is because there may be a link between the disorder and serotonin levels, and antidepressants might be effective. However, other medications may also be suggested by doctors.

One treatment for trichotillomania that doctors regularly suggest is acetylcysteine (Mucomyst), which aids in modifying TTM's rewarding effects. Also, for TTM, it is advised to take tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRIs), two antidepressants.

3. Lifestyle Changes

TTM can negatively affect a person's lifestyle and general well-being. So, Individuals should adopt healthy lifestyle modifications to alleviate symptoms to dwindle their influence:

• Giving Attention to Physical Health: Even though disciplined eating, getting enough sleep, and scheduling time for physical activity won't entirely eliminate hair-pulling problems, they will improve a person's general health. In addition, this modification may curtail underlying disorders since people tend to experience fewer symptoms of despair and anxiety when their physical health is working effectively.
• Cultivating Positive Experiences and Feelings: Individuals may need to discover several alternatives if they wish the pulling to stop because TTM can either mask or induce desired feelings. So, find things you enjoy doing, issues you care about, and companions for some adventures.
• Staying Open About Your Problem: Too many people try to conceal their hair-pulling habits, increasing their feelings of guilt and shame and reducing their chances of getting help. So, even while it's unnecessary to shout one TTM from the rooftops, letting a select few people know can help with acceptance and care.
• Helping Those in Need: People with mental health conditions like TTM frequently concentrate on their signs, difficulties, and experiences. However, concentrating on those in need can be a favourable option when done in moderation. Also, the symptoms might improve if you donate your time or talents to a worthwhile cause.

It is essential to consult your doctor if you can't control your urge to pull hair and if you feel satisfaction after pulling a hair out. Also, consult your doctor immediately if you witness bald patches on your scalp resulting from hair pulling.

Trichotillomania cannot be prevented singly. However, addressing the underlying unfavourable feelings may aid in preventing the recurrence of the temptation to pull your hair out. Finding ways to manage your stress and lessen it could help you feel less like yanking your hair out. You might also want to look into stress management therapy.

Trichotillomania is a widespread illness that affects individuals worldwide and is thought to be curable. In this regard, therapy and medication are just two options for managing it. Also, you can diminish its effects if you are well aware of the causes of trichotillomania and stay aloof from those in the first place.