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Trichotillomania (TTM) is a compulsive urge to pluck out hair, resulting in noticeable hair loss. It is also referred to as ‘compulsive hair pulling’. TTM has been classified as both one of the families of Obsessive Compulsive Disorder as well as an Impulse Control Disorder. It involves the repetitive, uncontrollable pulling of one’s body hair. Most commonly, scalp hair, eyelashes, and eyebrows are pulled, although hair may be pulled from any location. Trichotillomania is more common in children than in adults and occurs more frequently in women than in men. Hair pulling is the chief complaint in about 0.5 percent of all patients who present to children’s mental health services.

Typical symptoms of Trichotillomania include:

• 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 causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).

What causes trichotillomania? It is likely that genes make people vulnerable to trichotillomania and related conditions. Hardly any research has been conducted. In some cases of trichotillomania, stress plays a causal role, and hair-pulling can be seen as a soothing behavior that is driven by rising tension. For others, hair-pulling is undertaken during times of relaxation and may in fact serve a self-stimulatory role, or even run automatically. Environmental factors can also contribute to the onset. People with TTM often feel depressed and ashamed and have low self-esteem.

The primary treatment approach for Trichotillomania is habit reversal combined with stress management and behavioral contracting. Parents can help by recognizing the problem in its early stages and getting involved in its treatment. Treatment may involve self-monitoring of hair-pulling episodes as well as the feelings and situations that are most likely to lead to hair pulling. Youngsters are then systematically introduced to new behaviors, for example, squeezing a ball or tightening their fist, whenever they feel the urge to pull at their hair. Relaxation training and other stress reduction techniques may also be used including reward charts that help track and monitor a child’s progress with the added incentive of earning small rewards for continued progress. In addition, cognitive therapy, is found to be effective.

One of the numerous hair loss conditions people tend to suffer from today is telogen effluvium. Telogen effluvium is a hair loss condition that is characterized by a general thinning of the hair over a period of months. It is usually found in people who have recently experienced trauma with common causes including childbirth, major surgery and severe illness.

Telogen is the name for the relaxing stage of the hair growth cycle. Telogen effluvium is a form of non-scarring alopecia distinguished by diffuse hair shedding, often with an acute onset. A telogen effluvium is when some stress causes hair roots to be pushed precociously into the resting state. Telogen effluvium can be severe or chronic. Hair growth happens in a cycle which is divided into three phases: a growth phase, a regression phase and a resting phase. Various hairs are in different stages of the cycle at any one time. Telogen effluvium may affect hair on all parts of the body, but, normally, only loss of scalp hair is symptomatic. Generally, most of the hairs are in the growth stage. In this condition, one can lose over 300 hairs per day.

A considerable number of different causes for telogen effluvium exist. Among the common causes are:

• Surgery
• Severe infections
• Severe chronic illness
• Major physical trauma
• Major psychological stress
• High fever or severe infection
• Extreme weight loss
• Extreme change in diet and “crash dieting”
• Abrupt hormonal changes, including those associated with childbirth and menopause
• Iron deficiency
• Hypothyroidism or hyperthyroidism

Diagnosis of telogen effluvium involves a three step process:

1. Assess the type of hair loss suffered - generally telogen effluvium is typified by a rapid thinning throughout the scalp rather than the localized loss evident in most other conditions.
2. Review life events over the previous six months - typically some sort of traumatic event will have occurred.
3. Undergo a hormone test to rule out other abnormalities.

As far as treatment is concerned, telogen effluvium usually disappears as the effects of the trauma previously experienced begin to wear off. Consequently, there are no treatments specific to this condition although a product such as minoxidil may help to accelerate the regrowth process.

Alopecia areata (AA) is a non-scarring, inflammatory, hair loss disease that is seen in men, women and children. It is an unpredictable autoimmune skin disease that affects approximately 1.7% of the US population, according to the National Alopecia Areata Foundation. It often appears first in childhood and its most benign form presents as non-inflamed bald spots on the scalp. Alopecia areata can progress to total hair loss on the scalp (alopecia totalis) or complete hair loss all over the body (alopecia universalis).

Although great progress has been made in the research of hair diseases, the exact etiology of alopecia areata is still to be established. However, there is a lot of evidence to support the fact that alopecia areata is a multi-entity disorder with causes that are multifactorial, including evident autoimmune and genetic components. The disease presents with the loss of scalp and body hair by interruption of their synthesis. There is no destruction or atrophy of the follicles, and therefore the hair loss can be reversible.

Normally, hair growth in each hair follicle occurs in a cycle. There are three main phases of the hair growth cycle anagen (active growth phase), catagen (period of controlled regression) and telogen (resting state in the hair follicle cycle). Alopecia areata primarily affects the hair follicle as it enters the anagen phase, and studies further indicate that the initial event in the development of alopecia areata is the premature precipitation of anagen follicles into the telogen state or resting state of the hair follicle cycle.

The underlying cause of alopecia areata, alopecia totalis and alopecia universalis is unknown. Studies suggest that the body’s inflammatory response somehow begins to attack hair follicles, an event that precipitates hair loss. The process continues unless the immune response is somehow halted, either spontaneously or with drug therapy. Approximately 20% of affected individuals have a family history of the condition. Moreover, the occurrence of alopecia areata is often linked with other autoimmune conditions, such as atopy (allergy) or lupus erythematosus.

No cure exists for alopecia areata. The most effective treatment often includes a combination of different therapies, depending on the extent of hair loss. In mild cases, steroid injections are given and hair regrowth usually occurs within a few weeks. Minoxidil, which is indicated for treating androgenetic alopecia, has also been prescribed to treat alopecia areata. Oral cortisone is often given to people with more significant hair loss, but is associated with side effects over longer-term use. Topical treatments include corticosteroids, cyclosporine (an immunosuppressive agent) and anthralin, a synthetic substance primarily used to treat psoriasis.

When you suffer from alopecia areata, it is unfortunate that no one is able to answer the question, “Will my hair grow back?” We just don’t know. In some cases, where there are small patches, and they’ve appeared quite suddenly and remained small, regrowth is quite often spontaneous. If they begin to spread, the greater the area that is covered, the less chance of recovery, is the general rule, but not always. There are cases where people have lost their hair for over 20 years with alopecia areata who, for some reason which nobody understands - science certainly doesn’t - suddenly the hair regrows.