Trichotillomania affects both children and adults. In early childhood, the condition affects both boys and girls in equal number, and the condition is likely to go away on its own. Those who start pulling out their hair around adolescence are more likely to be women and are also more likely to need medication or therapy to stop their behaviors.
If someone pulls out their hair, large bald spots and missing eyebrows and eyelashes would seem to be a clear indicator of the action. However, people with trichotillomania go to great lengths to disguise what they've done, as many feel shame or guilt over destroying their hair, which is so often prized as a symbol of beauty or power. Many invest in wigs, hats and kerchiefs to hide bald spots on their heads, while eyebrows may be painted on (eventually, hair will grow back, but years of pulling will do permanent damage to the follicles).
These people may avoid swimming or walking around on a blustery day at all costs, and some avoid all forms of intimacy and medical care. A woman, for example, may refuse to see a gynecologist so that no one sees that she pulls from her pubic hair. If a bald spot can't be hidden properly, some trichotillomania sufferers have claimed they were enduring cancer treatment rather than admit that they pulled the hair out themselves [source: Landau].
After pulling out their hair, many people with trichotillomania play with it in some way. The most common thing to do with the pulled hair is to chew on it or eat it, a practice known as trichophagia. When a person eats a lot of hair, trichobezoars, or hair balls, develop. As the trichobezoars get larger, they can cause vomiting, constipation and other, often serious gastrointestinal ills. Trichobezoars may need to be removed surgically.
Repeatedly pulling out one's hair can cause injuries to the arms, such as carpal tunnel syndrome. In addition, many people with trichotillomania also have depression and anxiety disorders. Because trichotillomania is often linked with these conditions and other negative feelings, like stress and loneliness, you may think that trichotillomania as something that only certain people need to worry about. On the next page, though, we'll consider how the causes of trichotillomania may be more complex.