Trichotillomania (Hair Pulling Disorder)

Trichotillomania (TTM) or hair pulling disorder (HPD) is defined as a recurrent pulling of one’s own hair leading to significant hair loss, i.e. self-inflicted alopecia, traction alopecia or mechanical alopecia, accompanied by repeated unsuccessful attempts to decrease or stop the behaviour. TTM often onsets following a stressful event or when one is in persistent distress. It is important to identify an acute stress (death of a partner/significant other, parental divorce, employment termination, etc.) or chronic stress (ongoing domestic violence, poor scholarly or job performance, long-lasting overwork, etc.). It is essential to overlook the general situation of an individual’s life circumstances, as there could be important signs of positive or negative reinforcement for hair pulling. Optimal or gold standard treatment is still lacking. Psychiatric referral is recommended, however, there could be other organisation forms like multidisciplinary psychodermatological clinics or consultation-liaison services. There is evidence for pharmacological treatment, as for psychotherapy. A combination of both may be more effective than either approach independently. In this chapter, the evidence for psychodermatopharmacology, psychotherapy and other therapies will be discussed.