A good percentage of the population could tell you they know somthing about attention deficit disorder (ADD), obsessive compulsive disorder (OCD), and manic depression (bi-polar), but how many people know about trichotillomania (TTM)? I've found that the majority of people I've talked to have not a clue what it is unless they have it themselves. The first task to unravelling the mystery to what the average trichotillomaniac suffers, it would be benefitial to find out first where the word derives from, and hence what it means. Then one may go further into technicalities of TTM, and last, possible treatments.
The term was first created by a French dermatologist in the late 1800s to describe what he saw in his patients as a compulsive or irresistable urge to pull out their hair. The word is derived from the Greek words thrix (hair), tillein (pulling),and mania (madness or frenzy). Hence TTM can be known as a "hair pulling madness or frenzy". There is one misleading factor in that analysis, though, and that is rooted in the word mania. This disorder is not associated with a person being "mad" or "crazy", but would be better looked at as an Impulse Control Disorder (as any compulsive behavior might be placed under).
For a formal definition of trichotillomania, review what the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) says about it. For those of you who do not understand what kind of feeling a trichotillomaniac has for pulling out their hair, my Aunt Marlene, one of many sufferers of this disorder, gave me a descriptive that might make the sensation easier to comprehend. Imagine yourself driving down a backroad (maybe crosscountry), and that 32 oz soda you drank a few hours back has reached your bladder. You decide to keep driving in hopes of finding a service station or something where you could find a restroom, but you find none. Eventually, the urge is too great, so you pull off to the side of the road, and release the tension that soda put on your bladder. In relief, you go back to your car, and continue your journey. In the mind of a trichotillomaniac, they feel the same way about pulling out their hair. The tension rises, becomes too great to resist, so they pull. Then, when the urge has passed, there is a sence of relief, and they can go about doing what they were doing before. Now imagine feeling that tension everyday, with no escape from a habit you cannot break. That is the life of a trichotillomaniac.
Now with all the breakthroughs in technology, you might assume that there is a cure for trichotillomania, but alas, none have been discovered. There are many methods of reducing the urges (which varies depending on the individual), but no magical potion that will make them go away. Many have done research on trichotillomania, and have posted possible treatments on the internet as well as in books and magazines. One such posting on the net was done by John R. Kender and Michael J. Grant. John is a university professor who pulled eyebrows for 30 years, and Michael is the father of a hairpuller. They wrote this paper to inform other TTM sufferers that there may still be hope, and there are things they can try before they give up altogether and give in. One of the methods they talk about is in regulating ones diet. Food items they say might make the urges more intense. Such items include chocolate, caffiene, sugar, egg yolks, legumes (mainly peanuts), or fatty fish (such as tuna). The list of "bad" foods is much longer, but it is available on written request. There are foods that can help counteract the "bad" foods, and these include "garlic, most acidic fruits, dry red wine, unsweetened yogurt, and a chemical family calledgluconates" (Kender). The list of possible causes and treatments goes on, but my purpose is just to inform the reader on some of the more basics on TTM.
Trichotillomania is no ordinary disorder, and definitly not a highly publicized one, but it does exist. Estimates say that three to eight million people in the United States alone suffer from it, and a large portion of them are "closet TTMers". Support groups are minimal, but as publication spreads about TTM, more support groups are being created, and more people are getting help. I myself have TTM. My impulses started when I was in third grade. It is not something I am proud of - no, but it would have been easier if I had someone there to support me. Now I contact members of various TTM online groups through my aunt and talk to people my age that share the same problems that I do. It is comforting to know that I'm not the only one, and it feels good to be able to share my knowledge of TTM with others.
BIBLIOGRAPHY
Kender, John R. and Grant, Michael J. "Trich, Food, and Skin Care." 13 October 1999.
Trichotillomania Learning Center Online. (Excerpt from: Trichotillomania: A Guide, 1994.)
"Impulse control disorders are characterized by the inability to control or resist the temptation (or impulse) to do something harmful to oneself or someone else. A sufferer sometimes experiences a sense of increasing tension before performing the behavior and can feel a sense of relief or release of tension afterwards. Sometimes people even express a degree of pleasure after having performed the act."
"Features of trichotillomania that fit the description of an impulse control disorder include the inability to resist urges to pull out one's hair, mounting tension before pulling and feeling of relief afterward." Back
Recurrent pulling out of one's hair resulting in noticeable hair loss.
An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.
Pleasure, gratification, or relief when pulling out the hair.
The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatologic condition).
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Back
John R. Kender and Michael J. Grant
Nutrition and TTM (John writes)
Seven years ago, by keeping careful records of what I ate, I noticed that certain foods tended to increase my urges to pull. By avoiding those foods, I began what is now a seven year remission: no urges, and no hairpulling. Numerous experiments, some even with my dog who had a problem with compulsive paw licking, confirmed that some foods were "bad", meaning that they increased hairpulling urges and sometimes increased an itchy "this hair is out of place" feeling. I wrote in a previous issue of InTouch four years ago about some of these experiments.
Since then, based in part on written and email reports from other pullers, the list of "good" and "bad" foods and of other food-related techniques has been refined, and there is now a better understanding of the strengths and weaknesses of this approach. As of the Summer of 1999, over 100 people, including about a dozen children and adolescents, and several dogs, have reported or have been reported as obtaining from "good" to "total" relief, for a week to years, using some or all of these techniques. More than two dozen of these pullers report from two months to three years' worth of benefit. At the same time, the number of people reporting increased urges and hairpulling after eating "bad" foods has been so numerous (on the order of several hundred) that I have stopped keeping track of them, even electronically. On the other hand, we have received a few reports of earnest attempts at dietary control measures that have failed, most of them appearing to be from lash pullers....
Skin and Hair Care and TTM (Mike writes)
My continuing interest in the relationship of certain types of scalp conditions and TTM has been an outgrowth of my daughter Terri's experience which began more than five years ago. At the time Terri was diagnosed with TTM, she had already been under a dermatologist's care. She had what was thought to be spontaneous hair loss due to alopecia areata, as well as due to an inflammatory condition of the scalp that had progressed to the point of forming sores which she would want to pick at due to their intense itching. The condition of Terri's scalp was thought to be a medical consequence of her primary impulse control disorder.
In the years that have followed, through Terri's experience as well as my own participation with children and adults in the TTM community, I discovered a group of hairpullers who share the same scalp symptoms. Further, observing these scalp conditions over time, I have noticed that in many instances the scalp conditions preceded, not followed, the hairpulling. The pulling appeared to be triggered by the inflammatory process, much like the scratching behavior most of us have in response to conditions such as mosquito bite, poison ivy, or athlete's foot. I speculated that it might be possible in some instances to reduce or eliminate the hairpulling behavior simply by alleviating the inflammatory trigger.... Back