A obsessive-compulsive disorder afflicting somewhere between two and four million Americans which causes them to pull out their own hair. I am not making this up. Most of them are women who begin suffering in their teens or twenties. Prozac combats this quite well, and can sometimes make it disappear completely.

From the DSM IV:

312.39 Trichotillomania

Diagnostic Features
The essential feature of Trichotillomania is the recurrent pulling out of one's own hair that results in noticeable hair loss (Criterion A). Sites of hair pulling may include any region of the body in which hair may grow (including axillary, pubic, and perirectal regions), with the most common sites being the scalp, eyebrows, and eyelashes. Hair pulling may occur in brief episodes scattered throughout the day or in less frequent but more sustained periods that can continue for hours. Stressful circumstances frequently increase hair-pulling behavior, but increased hair pulling also occurs in states of relaxation and distraction (e.g., when reading a book or watching television). An increased sense of tension is present immediately before pulling out the hair (Criterion B). For some, tension does not necessarily precede the act but is associated with attempts to resist the urge. There is gratification, pleasure, or a sense of relief when pulling out the hair (Criterion C). Some individuals experience an "itchlike" sensation in the scalp that is eased by the act of pulling hair. The diagnosis is not given if the hair pulling is better accounted for by another mental disorder (e.g., in response to a delusion or a hallucination) or is due to a general medial condition (e.g., inflammation of the skin or other dermatological conditions) (Criterion D). The disturbance must cause significant distress or impairment in social, occupational, or other important areas of functioning (Criterion E).

Trichotillomania is one of the differential diagnoses that should be considered whenever unexplained hair loss is the presenting symptom.

If the obsessive-compulsive disorder (OCD) extends to eating the hair pulled out, this can lead to a weird condition known as a bezoar causing bowel obstruction.

Until about a little over a year ago, I never knew that Trichotillomania existed. Until that point, I just figured that I had a general obsessive disorder. Unlike many peoples' Trichotillomania, mine has progressed no further than to my eyebrows. Yet, it is still something that I have to deal with.

My sophomore year of high school was when this all started. I had fairly normal-looking eyebrows. Well, at least there were two of them. I don't know that there was any particular event that made me start plucking my eyebrows. I just started. At first, I started plucking hairs that looked as if they had black roots. That lasted for a long time. As I kept plucking more of the black-rooted ones, more grew. I decided that it would be "fun" to pluck the new ones, too.

I think that eventually it didn't matter what kind I plucked. It was just something that I did.

By this point, the hairs left in my eyebrows had diminished to a miniscule amount. People at school asked me questions about them. My answer was always that I wouldn't tell. I said that only one guy was there when the "losing my eyebrows" incident occured, and that no one else could know about it. I figured out in my head that I didn't actually lie. God was the one guy who knew what I was doing.

So the days of painting on my eyebrows continued into my junior year. It was getting to the point that I decided something had to be done about it. I tried to change slowly. I decided that I wouldn't pluck the full-grown hairs anymore, just the new ones.

This worked well enough to the point that I had two semi-normal eyebrows again. Although, everyday for the rest of my high school career, and even now in my college years, I deal with Trichotillomania.

It isn't easy to deal with, but neither are most impulse-control disorders. Because of what I have done, hairs grow in the middle of my eyebrows. I know that I want to keep these plucked. However, everytime I pick up the tweezers, I want to pluck more than that. Thankfully, I have one thing going for me-- determination. I have talked with tons of people who have had trich for 30 plus years. I really don't want to be one of them.

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Well, to add a bit of info... The word trichotillomania is derived from the Greek thrix, hair; tillein, to pull; and mania, madness or frenzy.

This name is somewhat of a misnomer in that people with trichotillomania are not "mad", "psychotic" or "crazy" as the name suggests. Trichotillomania is actually an impulse control disorder. Impulse control disorders are characterized by the inability to control or resist the temptation (or impulse) to do something to oneself or someone else.

Trichotillomania in today's society is a more harmful disorder than many people realize. American society is heavily appearance-based. For a woman to be balding can be a matter of great embarrassment; for men, hair loss is already a sensitive issue in many cases. Watch television late one night and look at the Hair Club for Men ads, or flip through a women's magazine and count the advertisements for products concealing hair loss. Now imagine that you're not only losing your hair, but you're causing the problem yourself.

Trich is a disorder only beginning to be studied in depth. CAT scans and other tests which require the patient to not move are difficult, since the brain activiy levels when the disorder is inactive (the person is not pulling) are no different from those of people not suffering from it. Innovations in medical technology are making the study of trichotillomania easier, however. Studies so far have shown that trich is actually more closely related to Tourette's Syndrome than the more commonly assumed OCD.

The SSRI family of antidepressents has been shown to help trichotillomania when prescribed at high doses, but is not a guaranteed cure. Anti-anxiety drugs are sometimes prescribed, since in some patients the symptoms of the disorder manifest more strongly when the patient is stressed. There is also a school of thought which suggests that since sufferers frequently admit to finding the sensation of hair pulling pleasurable, the disorder should be treated as if it were an addiction.

If you're looking for more information about Trichotillomania, current research, or just want to know how other sufferers are dealing with the disorder and their lives, you might want to look into the Trichotillomania Learning Center. Along with their activism programs, they also run a newsletter called In Touch, with information about the disorder, support groups in your area, and ways you and those close to you can help out.