The vicious circle of self-inflicted hair loss

"I tried not to make a big deal of it as I thought I'd make it worse. I thought it was probably just a bit of a stage and that she would grow out of it," says Susan, from Hull.

But rather than growing out of it Becky's hair-pulling got worse over the years. She started to pull out all her eyelashes and eyebrows and now pulls out large chunks of hair.

Most of the time she has no idea she is doing it and doctors have put her on anti-depressants in a bid to make her stop, despite her being only 15-years-old.

Becky, not her real name, suffers from a condition called Trichotillomania.

It is a condition, often caused by stress, in which the sufferer physically pulls their hairs out, usually one at a time.

Many believe there is a genetic element to Trichotillomania and that some people carry a gene which leaves us with less impulse control than others. It is also commonly thought that hair-pulling can result from trying to gain control over some part of our lives. There is a theory that all impulse control disorders are connected with loss.

Iain Sallis is the only hospital-based trichologist in the UK who looks into the causes and effects of hair problems. He says he is seeing more people coming to him, including Becky, desperate for help.

"GPs just don't seem to take hair problems seriously. They tend to prescribe anti-depressants as in Becky's case, but that just masks the real reason why they have got into the habit and just makes them feel better about pulling their hair out."

Susan says Becky's hair pulling got worse after her father walked out.

"When she was about 10 she completely pulled out her eyelashes and eyebrows which made her look very strange. When I asked her why she'd done it she didn't even realise that she had. I took her to the doctor and he said not to make an issue out of it," said Susan.

"Then when she was nearly 11, her dad left to go to live with someone else. She completely pulled all the hair out on the top of her head, like a monk's. She said she didn't know she'd done it, but she was in denial."

It has continued since then, getting progressively worse.

"She doesn't pull large chunks out; she pulls out one strand at time. She says it gives her feeling that is hard to describe but says she can't stop."

Becky's unusual appearance has led to severe bullying, which leads to worse hair pulling.

She has changed schools a number of times, is now being taught in virtual isolation and refuses to travel on the school bus because of the bullies.

As a result of the constant attention and name-calling Becky's self-esteem is very low.

"She wears extensions now which helps her confidence a little, but you can still see where the bald and scabby patches are. It is pretty bad at the moment."

Susan believes it all started when Becky first started school.

"She has always been school phobic and looking back the starting of the hair pulling coincided with her starting school."

Iain Sallis believes that once a person starts, it becomes a habit which is very difficult to break.

"You will usually find that sufferers repetitively pluck their hair in times of stress or as a comforter the same way babies sometimes play

with their mother's hair

while falling asleep in their arms.

"The main problem of this is that most people who suffer from it do not know that they are doing it, it's so habitual, or they are in total denial that they do it," says Iain.

"This is not a hair problems per se; there is nothing wrong with the hair. The hair loss is usually patchy and irregular, and characterised by broken hairs of varying length.

"Within the patches, hair loss is not complete. As long as the hair trauma was not severe or chronic enough to cause scarring, the hair will re-grow when the trauma is stopped.

"One of the main problems is that no one has any idea how widespread this is, but it isn't just in children."

Iain believes that one in 100 people could suffer some form of Trichotillomania.

As for Becky, she is hoping that a mesh which can be put over her scalp with false hair attached could help her, at least to stop the bullying.

"I can't ever imagine a time when I'm not doing it," she says. "I just can't seem to stop."

"She desperately wants to stop," says Susan. "She has been in tears, and so have I."

Susan and Becky now want to raise awareness of the condition not just among the public but among the medical profession.

"When I told my doctor that Becky had Trichotillomania he said he didn't have a clue what I was talking about. The name doesn't help. When people hear the word 'mania' they immediately think she is mad."

Trichotillomania Support Online drops the "mania" and refers to the condition as "trich" in an attempt to avoid the stigma.

The group offers help and advice to sufferers.

Iain added: "If you are concerned that you or a loved one is suffering from Trichotillomania, speak with their GP, who should then arrange suitable counselling or a cognitive therapist to deal with this problem.The earlier someone gets help the better."

www.hairmedic.co.uk

www.trichotillomania.co.uk

An obsessive condition

Trichotillomania (TTM) is classed in the same category as obsessive compulsive disorders (OCD) and self- harm.

The severity can vary between severe (full or partial head plucked) or mild (one place in particular, ends of the hair or eyebrows/eyelashes).

It is more common than people think, hair twiddling and constant stroking are all mild versions of the same thing, as is trichophagia, which is the habitual eating of hair.

Trichotillomania affects between one and three per cent of the population and is thought to affect more women than men.

Hair pulling usually starts at around 12 years of age, but has been known to affect all ages.