When a person begins pulling their hair out at adolescence, the initial trigger may be a stressful event, and the hair-pulling continues to be a self-soothing mechanism during times of stress, anxiety, fatigue or frustration, not unlike nail-biting. For some people, though, the trigger isn't necessarily stress or depression, and hair-pulling can occur at anytime, stressful or not. The wide array of situations in which trichotillomania presents itself makes it difficult to classify as a condition. For example, some doctors liken it to obsessive-compulsive disorder (OCD), but the repetitive hair-pulling is driven more by impulses, rather than obsessive thoughts. In that way, it's more like a tic.
This connection was borne out in 2006, when researchers at Duke University found that a small percentage of people with trichotillomania had mutations in a gene called SLITKR1 [source: Duke University]. SLITKR1 has also been linked to Tourette syndrome, in which people experience tics like eye-blinking or twitching. Even though mutations were only identified in a small number of cases in the Duke study, it suggests a neurological underpinning for a condition that's often just blamed on negative feelings.
If it's clear that a person is suffering from both depression and trichotillomania, though, doctors will often suggest anti-depressants as part of the course of treatment. Selective serotonin reuptake inhibitors (SSRIs) don't address the impulse to pull hair, but they may help address an underlying cause. The drug clomipramine, sometimes diagnosed in cases of OCD, has curbed the hair-pulling urge in some patients. In 2009, researchers found that N-Acetylcysteine, an antioxidant found in health food supplements, curbed the impulse to pull one's hair significantly in comparison to subjects given a placebo [source: University of Minnesota]. (Before beginning any new medication or supplement, patients should speak to their doctor about possible interactions with other medications.)
In addition to medication, cognitive behavior therapy (CBT) is also recommended for those with trichotillomania. The goal of CBT is to learn to replace one behavior with another, so first patients are taught to be aware of when they pull their hair, be it absent-mindedly in front of the television or in times of immense stress. Then, therapists will suggest behaviors that they do instead of hair-pulling when those situations arise in an effort to alter the habit. Some people may make simple modifications like wearing gloves in their sleep.
With the rising awareness of trichotillomania, there are an increasing number of support groups available for people with trichotillomania, but be aware that many doctors may not have seen an actual case in their office yet. No single treatment has been proven to work for everyone, and it may take some mixing and matching of these treatments to find the one most effective for a person.