Science Explains Why People Pull-Out Their Hair To Hurt Themselves

November 11th 2015

People who pull out their hair may have a condition called trichotillomania, or TTM.

What is TTM?

Trichotillomania is a type of impulsive control disorder, and it’s pronounced like this: trick-o-til-o-MAY-nee-ah. People who suffer from TTM feel irresistible or uncontrollable urges to pull or twist their hair repeatedly until it breaks off, the National Institute of Health reports.  TTM sufferers may pull hair from the scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs, or other parts of the body, the Trichotillomania Learning Center says. 

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People with the disorder may make repeated attempts to decrease or stop the behavior. TTM causes “clinically significant distress or impairment” in important areas of functioning, such as in social situations, work, or school, the Learning Center says. Another indicator of TTM is if a person is losing hair, but doesn't have a medical condition or disorder that could cause hair loss.  

Who is affected by TTM?

TTM affects as much as 4 percent of the population. Women are four times more likely to be affected by the disorder than men, according to the NIH. The disorder is usually first seen before the age of 17, and the hair-pulling behavior only lasts for about a year, the NIH says. But some people deal with TTM as a lifelong disorder, and it can be very difficult to live with.

Rebecca Brown is one of those people. Brown, more commonly known by her YouTube name Beckie0, tallied more than 1 million views openly discussing her struggle with TTM in a YouTube video.

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After Brown posted her video, ABC News contacted her to talk about her illness. "That video exploded," she told ABC, adding: "It really opened my eyes to how big the condition was. ... I thought I was on my own." Watch the full interview below.

What are the warning signs of TTM?

Beckie0 TrichotillomaniaYouTube/Beckie0 -

TTM is most commonly characterized by the recurrent pulling out of hair, resulting in hair loss, according to the Diagnostic and Statistical Manual Five. Some warning signs of TTM, according to the Learning Center:

  1. Wearing hats, scarves, or wigs
  2. Wearing eye makeup and glasses
  3. Excessive hair fiddling
  4. Anxiety or depression and career or academic decline
  5. Avoidance of windy or wet situations, including swimming
  6. Changes in social behavior patterns
  7. Bowel obstruction or blockage, if the person eats the hair they pull out

Beckie0 on ABCBeckie0/ABC -

Talking to an expert.

ATTN: spoke with Stephen Whiteside, a child psychologist at the Mayo Clinic, about the condition. 

ATTN: Can you explain trichotillomania on a basic level?

Whiteside: It's generally understood to be called a habit disorder, which is probably not a great term, because it minimizes the severity of the problem. But it’s generally thought to be [that] you have this uncomfortable sensation: This hair doesn’t feel right, doesn't look right, and you have this urge to pull. 

Beckie0 on ABCBeckie0/ABC -

After pulling that hair, there’s this release of stress, kind of this positive sensation that really reinforces repeating that action. And it’s a very hard cycle to break, and it’s often done outside of our awareness — we’re not consciously aware of how much we’re picking or pulling. Some people tend to pull more when their hands are idle, but certainly there’s also a stress component, when people feel stressed out, they tend to pull more. One misconception is that it’s a symptom of an underlying problem, when most likely hair pulling is the problem itself.

ATTN: What are some reasons people might feel uncomfortable talking about trichotillomania? 

Whiteside: Unfortunately, there’s still a stigma around mental illness, with people feeling generally embarrassed about the symptoms. I think often times there’s a sense that they should be able to control it, and they feel different. Especially with kids, when they have a challenge like trichotillomania, or depression, or anxiety, they feel different, and that’s a scary feeling. 

ATTN: Is it difficult to get research funding for trichotillomania? If yes, why?

Whiteside: I think that it’s difficult to get funding to do any research, and I think that’s particularly true of mental health issues, and probably even more so true with child mental health issues. One [reason for this], I think, is continuing stigma [around mental health issues]. People are much more comfortable talking about medical illnesses in general, compared to mental health.

Beckie0 on ABCBeckie0/ABC -

ATTN: Is there anything that you believe the general public needs to know or understand about trichotillomania?

Whiteside: Mental illness is not a distinct problem that some people have and that nobody else has. It’s more a continuum of normal everyday experiences. … Even though you feel alone and you feel different, in reality, most people have some level of understanding of those symptoms, and there are a lot of people who you look at who you think are normal, regular everyday [people], and they suffer with mental illness.

ATTN: Do you have any advice for people suffering from this illness or other mental illnesses? 

Whiteside: There’s help available. The vast majority of people do not receive help for mental health problems, but there are effective treatments, including for trichotillomania. There are behavioral treatments and medications that can be effective. Understand that this is something that is common, that you’re not alone, other people experience this, and it is something that can be improved, you can get treatment.

Beckie0 on ABCBeckie0/ABC -

What are treatments for TTM?

Not all mental health professionals agree on the use of medication for treatment of TTM, the NIH says. But certain medications like naltrexone and selective serotonin reuptake inhibitors, or SSRIs, may reduce some symptoms. Behavioral therapy and habit reversal may also be effective, the NIH says. 

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For treatment and resources, explore the Learning Center's website, which can help educate you and direct you to resources about TTM.