BACKGROUND: A French dermatologist coined the term trichtillomania in 1889 to describe the irresistible or compulsive urge he saw in patients to pull out their hair. The word trichtillomania comes from the Greek thrix, for hair; tillein, to pull, and mania, madness or frenzy. The name is a misnomer, to some degree, in that people who suffer from trichtillomania are not 'mad' or 'crazy' as the name might suggest. This disease is classified as an impulse control disorder. These disorders are characterized by a patient's inability to control or resist the impulse or temptation to do something harmful to him or herself or to someone else. In some cases, the sufferer experiences a sense of increasing stress or tension before performing the behavior, in this case, plucking or pulling of hair, and can experience a sense of relief or a release of stress or anxiety afterwards. More formally, the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defines trichtillomania as:

•Recurrent pulling out of one's hair, resulting in noticeable hair loss

•An increasing sense of tension immediately before pulling out the hair, or when attempting to resist the behavior

•The disturbance is not better accounted for by another medical disorder, and is not due to a general medical condition (e.g. a dermatological condition)

•The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

DIAGNOSIS AND TREATMENT: Onset of this condition is generally in the early adolescent or pre-adolescent years. According to the National Institutes of Health, the typical first-time hair puller is 12 years old, although trichtillomania can affect people as young as one-year-old and as old as 70. It's believed that 90 percent of those with trichtillomania are women, but there is speculation that in men may simply be less likely to seek treatment for the condition. Symptoms include:

•Constant tugging, pulling or twisting of hair

•Increasing sense of tension is present before the hair pulling

•Sense of relief, pleasure or gratification is reported after the hair is pulled

•Bare patches or diffuse (all across) loss of hair

•Hair regrowth in the bare spots feels like stubble

•Some individuals may develop a bowel obstruction if they eat the hair they pull out

Early detection is the best form of prevention for this condition, as it leads to early treatment. Decreasing stress in the environment can also be beneficial. Typically, younger children tend to outgrow the behavior, and for most, hair pulling is time-limited to six months. Naltrexone, behavioral therapy and habit reversal have been shown effective in reducing some symptoms of trichtillomania.