Some people with trichotillomania pull out just their eyelashes or eyebrows; others focus on removing the hairs of their head, beard, pubic area, or arms and legs. Some pull out hair from all parts of their body.
Gary R. Gaffney, M.D., associate professor in the Department of Psychiatry at the University of Iowa College of Medicine, explains that other, less dramatic features that fall short of hair pulling are associated with trichotillomania, including examining the hair root, twirling it off, and pulling the strand between the teeth.
Behind the Terminology
The term “trichotillomania” was coined in the late 19th century by Hallopeau, a French dermatologist, to describe the compulsive or irresistible urge he saw in some patients to pluck out their hair. It’s composed of three Greek words: thrix, meaning “hair;” tillein, meaning “to pull;” and mania, meaning “madness” or “frenzy.”
TLC points out that the name is not really accurate, because people with trichotillomania are not “mad,” “psychotic” or “crazy” as the name suggests. In psychiatry, trichotillomania is classified as an impulse control disorder, as are conditions such as compulsive gambling, kleptomania (compulsive stealing) and pyromania (compulsive fire-setting).
The Diagnostic and Statistical Manual of the American Psychiatric Association, known as the DSM-IV, lists the five criteria for diagnosing trichotillomania as:
- 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
- a disturbance that is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition)
- a disturbance that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
As TLC explains, not all patients who pull out their hair meet every one of these criteria. Nonetheless, they still may have a distressing problem with similar features that might very well benefit from treatment.
Often a physical examination of a person’s scalp, face, extremities, trunk or pubic area is used by psychiatrists and dermatologists to confirm the diagnosis by making sure some other disease isn’t causing the behavior. As Gaffney notes, “All other causes of hair loss, including medical and dermatological ones, must be considered and ruled out before the diagnosis of trichotillomania is confirmed.”