Trichotillomania as defined is a person that compulsively pulls their hair from their scalp, arm, eyelashes, leg, or even pubic region. This compulsion leads to complete irreversible hair loss and bald areas on the affected area. Although this disorder is found even in infants, its more common in adolescents and adults. There are two sub groups of Trichotillomania; 1. Focused and 2. Automatic.
Automatic trichotillomania is where a person is unaware that they are pulling their hair. If fact it is described as a “day dreaming” of sorts and continually pulling the hair until it comes out. The focused trichotillomania is where a person may become stressed or depressed and begin the act of pulling on the hair, whereupon when it is finally pulled out a gratification occurs.
Children seem to fall into the category of the automatic or unconscious type of trichotillomania. Often children are seen to be in a “trance-like” state and literally do not realize the repercussions of this irreversible hair loss. Children mainly pull hair from the scalp and not other areas.  In severe isolated cases a “sleep-isolated trichotillomania” is where an individual will unconsciously will pull out their hair during sleep. Most children outgrow this disorder.
Sometimes the hair pulling goes in a manic form where the individual will suddenly pull his/her hair for hours, days months. Other times the hair pulling rituals stop and do not occur for hours, days, or months. This disorder can be associated with other problems such as anxiety, post traumatic disorder, depression and/or obsessive compulsive disorder. There may be a genetic tie as well.
A hair transplant can be used to treat this disorder, however a full year of psychiatric treatment as well as a full year of no pulling must be completed at most experienced and fully disclosing clinics. Then it would be fine to transplant the affected area.
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