By June Cheong

Plucking your eyebrows or strands of white hair on occasion may be part of personal grooming but doing more than that may be a sign of a more deeply rooted problem - trichotillomania.

Trichotillomania is a condition characterised by a person's repeated urge to pull out his or her body hair, which can be on the head, nose, pubic area or the eyelashes.

This impulse control disorder can result in bald patches.

Dr Nelson Lee, the deputy chief of general psychiatry at the Institute of Mental Health, said: 'The patient usually feels some internal pressure to pull the hair, which is relieved by the act.

'But this is only temporary relief and pressure will gradually build up again.'

Dr Lim Yun Chin, a specialist in psychiatry at Raffles Hospital, added that the condition resembles a habit, an addiction, a tic disorder or an obsessive-compulsive disorder.

Trichotillomania often begins in a person's teenage years. It affects females more than males and patients typically start exhibiting symptoms between nine and 13 years of age.

Depression or stress can trigger trichotillomania. Doctors believe that the condition may be hereditary and caused by genetic factors as well as influenced by behavioural ones.

Dr Lim said that research has found a potential link between trichotillomania and certain brain chemicals called neurotransmitters.

Neurotransmitters help nerve cells in the brain send messages to one another. An imbalance of these chemicals can affect the way the brain controls impulses.

Patients with trichotillomania may also have other disorders like depression and anxiety.

As the condition manifests itself overtly, people with trichotillomania may suffer from related problems like body image issues.

Dr Lim said: 'An additional psychological effect may be their low self-esteem. They may fear socialising because of their appearance and the negative attention they may receive.'

Ms Shelwyn Tay, a clinical psychologist at the Centre For Effective Living, said: 'Patients tend to touch and play with their hair as well as pull it out. Baldness is a side effect of the hair-pulling and not the intention.

'As such, patients can be quite self-conscious about their bald patches and many take pains to stop or shift the site of their hair pulling.'

Patients either pull their hair out one by one or in clumps.

Roughly 10 per cent of trichotillomania patients eat or chew the hair they pull out - a condition called trichophagia.

This can cause hairballs to form in the stomach or small intestines, leading to pain, nausea and other gastrointestinal problems.

It is estimated that 1 to 3 per cent of the world's population is afflicted with trichotillomania.

The condition is rare in Singapore and only two doctors Mind Your Body spoke to had treated patients for it.

Ms Tay said she has only encountered one such patient although she has had other patients who exhibited symptoms of trichotillomania along with a host of other conditions.

Dr Lee said that a combined treatment approach, involving medication like anti-depressants and psychological intervention, is best.

Dr Lim said: 'People with trichotillomania may feel embarrassment, frustration, shame or depression because of their condition. They may feel nagged at by people who don't understand that they're not doing this on purpose.

'They usually try to hide their behaviour from other people and this can make it difficult to get help.'

junec@sph.com.sg

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This article was first published in Mind Your Body, The Straits Times.