Trichotillomania (TTM)

Diagnosis

To diagnose trichotillomania (TTM), your healthcare provider will first perform a physical examination, looking for visible signs of hair loss, and inquire about your medical and psychological history, as well as any current circumstances that might be relevant. They may also suggest a consultation with a mental health specialist who has experience treating TTM. Despite its relative simplicity to identify, patients often conceal their condition due to embarrassment or shame, making it challenging for healthcare providers to diagnose TTM through questioning alone.

For a more accurate diagnosis, a healthcare provider might conduct a “punch biopsy,” where a small piece of skin is removed for laboratory analysis. This test not only helps confirm the presence of TTM but also excludes other potential skin conditions that could be causing the hair pulling or loss. This thorough approach ensures that all possible medical and psychological issues related to the disorder are addressed.

Treatment

Many people have found that some treatment options help them stop or significantly decrease hair pulling. These consist of counseling as well as medication.

  • Medicines: Although there are no medications specifically approved for treating trichotillomania, certain medications might help alleviate symptoms like anxiety and despair.
    • Antidepressants: Your healthcare provider might suggest an antidepressant like clomipramine (Anafranil). Tricyclic antidepressants and selective serotonin re-uptake inhibitors, or SSRIs, can occasionally assist in reducing the urge to pull hair.
    • Antipsychotics. These medications support normal brain chemistry. Despite their seemingly singular name, these medications are effective in treating a variety of conditions, such as schizophrenia, bipolar disorder, and dementia.
    • Anticonvulsants: Along with assisting with TTM, these medications are commonly used to treat seizures and other conditions affecting motor function.
    • Nutraceuticals. These are nutritional products that may assist in the treatment of conditions, including supplements containing amino acids.

Consult your healthcare provider about any prescribed medications. One ought to balance the potential advantages of medications against any possible disadvantages.

  • Therapy: The following types of treatment could be beneficial for trichotillomania:
    • Habit reversal training: The primary procedure for treatment for trichotillomania is behavior therapy. You get better at identifying instances in which you’re most likely going to pull out your hair and at replacing those instances with alternative actions. For instance, you may try to resist the temptation by clenching your fists. When you sense the need to pull out your hair, one type of habit reversal training called decoupling includes immediately moving your hand away from your hair and toward another spot. Habit reversal training may be combined with other therapy.
      This type of treatment trains you to break habits like hair pulling by increasing your awareness. Out of all the TTM treatment options, this approach has the highest chances of success.
    • Acceptance and commitment therapy: You can learn to accept the desire to pull your hair without giving in to them with the help of this treatment.
    • Cognitive therapy: You can discover and analyze unrealistic beliefs you may have regarding hair pulling with the use of this treatment. You can get constructive perspectives about your medical condition.
    • Group therapy: Certain kinds of group treatment or support may be helpful for those with TTM.

Treatments for mental health issues including depression, anxiety, or issues with alcohol or drug use, which frequently coexist with trichotillomania, might play a significant role in the course of care.