hair pulling
© Cavale Doom/Flickr, CC BY-NC-ND
Many people look upon plucking the hair on their eyebrows or other body parts as a painful step of their grooming regimen. But some others have to fight the urge to do so. Their compulsive hair plucking sometimes leads to upsetting consequences. And scientists are still trying to untangle the reasons behind this condition, called trichotillomania.

The effects of trichotillomania have been written of since Hippocrates, but the condition didn't get a clinical definition until French dermatologist Francois Hallopeau recognized it in 1889. People with trichotillomania feel compelled to tug hair from their head, brows and eyelashes, or other areas. A subset of affected people also eat the hairs, which can build up into hairballs, causing gastrointestinal problems.Estimates suggest the condition affects up to 4 percent of the population (or about 12 million in the United States), and women arefour times more likely to be affected. Symptoms usually begin before age 17 and could last for years.

For some people, trichotillomania is a mild problem. But for many others, the condition can dramatically disrupt daily social life. The ensuing hair loss and feelings of shame about this behavior can lead people to avoid school, work or even seeking treatment for other medical problems. But as isolating and upsetting as the results can be for them, people with trichotillomania have great difficulty stopping; yanking their hairs out soothes anxiety, sadness and other negative emotions.

"Affected people typically report an intense urge to pull their hair, which can feel like a rising sense of tension or discomfort," wrote Imogen Rehm and Reneta Silkboer, researchers at the Swinburne University of Technology in Australia, at The Conversation. "Instead of feeling pain from the pulled hair, people with trichotillomania tend to experience a sense of relief or even pleasure."

Why people develop trichotillomania is unclear. Scientists do know that the condition is more than just a hard-to-break habit and believe that a number of biological, psychological and social factors may be involved. Trichotillomania runs in families, so it seems to be based partly on genetics. And findings from brain imaging studies suggest regions involved in impulse control, emotion processing, and reward-based learning might be different in people with the condition.

For some of the people with the disorder, pulling hair may reduce feelings of frustration and anxiety. One's beliefs and thinking style could also have a role, Rehm and Silkboer have found. Their new study found that self-critical thoughts or having a perfectionistic personality can prompt people to start or continue pulling out hairs. This finding suggests that people with trichotillomania may benefit from cognitive behavioral therapy, an approach that aims to change negative thinking and behaviors that are behind a person's problems.

When the researchers reviewed existing research on treatments for trichotillomania, they found that psychological therapies (specifically, variations of cognitive behavioral therapy) seem to be more effective than drugs at easing symptoms.

"But exactly how psychological therapy reduces trichotillomania symptoms remains to be understood," they wrote. "It's likely different treatment strategies work better for some people than for others."

However, one essential part of recovery from trichotillomania is to feel supported and less alone, the researchers said. To that end, a number of support centers and online communities have been set up, fromTrichotillomania Learning Center in the United States to online discussion groups on Reddit and documentations on YouTube.