Trichotillomania
Trichotillomania (TTM, also known as "Trichotillosis", or "trich" as it is commonly known, is an impulse control disorder characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV as an impulse control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the trich. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence of trichotillomania; 2.5 million in the U.S. may have TTM, with a 1% prevalence rate.
The name derives from Greek: tricho- (hair), till(en) (to pull), and mania.
Characteristics
Individuals with trichotillomania live relatively normal lives; however, they may have bald spots on their head, among their eyelashes, pubic hair, or brows. An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs, wear false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as 'pulling') whatsoever. This 'pulling' often resumes upon leaving this environment.
Many clinicians classify TTM as a habit behavior, in the same family as nail biting (onychophagia) or compulsive skin picking (dermatillomania). These disorders are a cross between mental disorders, such as obsessive compulsive disorder (OCD), and physical disorders such as stereotypic movement disorder because the person performs repetitive movements without being bothered by or completely aware of them. Some say that pimples on the scalp is all it takes to trigger the pulling in some of those who suffer from TTM. Supposedly, areas that are sore intensify the feeling of pulling. The more the area becomes agitated by pulling, the feeling intensifies, only causing the puller to become obsessed with pulling more. It is also widely believed that individuals with TTM pull because of the sight or feel of a certain area of hair. This theory varies by the individual, as some TTM sufferers say the disorder is not an obsession with looks but rather a habit or an addiction. The current classification of trich as an impulse disorder with pyromania, pathological gambling and kleptomania, has been called into question as inadequate and in need of revision. One study showed that individuals with TTM have decreased cerebellar volume. Anxiety, depression and OCD are more frequently encountered in people with TTM. People with TTM may also eat/chew the hair that they pull, referred to as trichophagia. In extreme cases this can lead to Rapunzel syndrome, and even death. Some individuals with TTM may feel they are the only person with this problem due to low rates of reporting.
Treatment
Habit Reversal Training or HRT, has been shown to be a successful adjunct to medication as a way to treat TTM. With Habit Reversal Training, doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. As a part of the behavioral record-keeping component of HRT, patients are often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well as what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes.
Treatment with clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to significantly improve symptoms.
Fluoxetine (Prozac) and other similar SSRI drugs have limited usefulness in treating TTM, and can often have significant side effects. According to F. Penzel, antidepressants can even increase the severity of the TTM.
A recent study has shown positive results using a treatment of acetylcysteine
Hypnotherapy has been used to treat it with some success by addressing the symptoms using hypnosis.
Additionally, there are individuals who are applying the 12-step Recovery Model, as created by Alcoholics Anonymous, to recover from Trichotillomania. The 12-step model addresses the spiritual, physical, and emotional components of suffering from a behavioral addiction. This treatment model challenges the idea that Trichotillomania is as an impulse control disorder.
Epidemiology
TTM is diagnosed in all age groups; it is more common during the first two decades of life, with mean age of onset usually reported between 9 and 14 years of age. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female.Evidence now points to a genetic predisposition.
The number of reported trichotillomania cases has increased throughout the years, possibly due to a reduced stigma associated with the condition. Estimates of the number of persons with TTM range from 1–3% up to 5% of the world's population.
http://en.wikipedia.org/wiki/Trichotillomania 
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