Genetic Factor

Scientists at Duke University Medical Center have identified gene mutations that cause trichotillomania, a psychiatric disorder that triggers people to compulsively pull their hair.

The disorder affects between 3 percent and 5 percent of the population and is considered an impulse control disorder. Patients with trichotillomania have noticeable hair loss or patches of baldness, but they often mask their habit. As a result, the disorder often goes undiagnosed and untreated, said researchers.

The relatively unknown disorder is often accompanied by other psychiatric conditions, such as anxiety, depression, obsessive compulsive disorder or Tourette syndrome, which are better known than the hair-pulling behavior.

The Duke team found two mutations in a gene called SLITKR1 that were implicated in trichotillomania patients. The mutations account for only a small percentage of trichotillomania cases, said the scientists.

However, their findings are significant because they validate a biological basis for mental illnesses. Such illnesses have long been blamed on a person’s upbringing or life experiences, said lead study investigator Stephan Züchner, M.D., assistant professor of psychiatry and researcher at the Duke Center for Human Genetics.

“Society still holds negative perceptions about psychiatric conditions such as trichotillomania. But, if we can show they have a genetic origin, we can improve diagnosis, develop new therapies and reduce the stereotypes associated with mental illness,” Züchner said.

Currently, there is no specific treatment for trichotillomania, although it is sometimes successfully managed with drugs used for depression and anxiety disorders.

Results of this study will appear in the October 2006 issue of the journal Molecular Psychiatry. The research was self-funded through Duke University.

The Duke scientists studied 44 families with one or more members who had trichotillomania. The researchers studied SLITRK1 because it was linked last year to a related impulse-control disorder called Tourette syndrome, which causes repetitive behaviors such as blinking, throat-clearing or shouting obscenities. The parent of one Tourette patient carried the SLITRK1 mutation but displayed only symptoms of trichotillomania, not Tourette.

The Duke team further studied SLITRK1 and found two mutations in the SLITRK1 gene among some individuals with trichotillomania but not in their unaffected family members. Mutations are changes in the structure of a gene that alter how the gene behaves. The researchers estimate that the SLITRK1 mutations account for 5 percent of trichotillomania cases.

The SLITRK1 gene is involved in forming connections among neurons, or brain cells. The researchers hypothesize that the two mutations in SLITRK1 cause neurons to develop faulty connections and that this faulty “wiring” produces the urge to pull one’s hair.

While SLITRK1 is the first gene linked with trichotillomania, numerous other genes likely contribute to this disorder and other psychiatric conditions, said senior study investigator Allison Ashley-Koch, Ph.D., assistant professor of medical genetics and researcher in the Duke Center for Human Genetics.

“The SLITRK1 gene could be among many other genes that are likely interact with each other and environmental factors to trigger trichotillomania and other psychiatric conditions,” Ashley-Koch said. “Such discoveries could open the door for genetic testing, which is completely unheard of in the field of psychiatry.”

Compared with neurological diseases, the identification of genes which underlie psychiatric disorders have only just begun, she said. Few other examples exist where a specific gene is known to trigger a psychiatric condition, although it is generally accepted that genetic factors play an important role.

Psychiatric illnesses are widespread, affecting one in four Americans, according to the National Institutes of Mental Health. They are the leading cause of disability for Americans between the ages of 15 and 44. The most common disorders are depression and anxiety disorders, such as panic disorder, obsessive compulsive disorder and social phobia.

October 1-8, 2006, is National Trichotrillomania Awareness Week.

Other researchers involved in this study were Michael L. Cuccaro, Khanh Nhat Tran-Viet, Heidi Cope, Ranga R. Krishnan and Margaret A. Pericak-Vance of Duke and Harry H. Wright of the University of South Carolina.

Retrain Your Brain

From HERE, we have an infinite number of possible futures, and our choices made now will determine our brain structure and chemical format tomorrow.

The question you ask now, and the action you take as a result, determines whether your brain responds with a good chemical response, or a bad chemical reaction.

Ask not? Why am I still pulling my hair out?? but “What haven’t I tried yet, to help me enter a new stage of Growth?” “It is not the answer that enlightens, but the question.” Decouvertes

Is it an Addiction?

“Often people ask me, “What can I ‘replace’ hairpulling with?” And certainly many pullers find things such as knitting, painting, Koosh balls, and other such activities involving the hands, to be helpful, especially children. And for children, such things may “do the trick,” so to speak. If you find anything like that to be helpful, by all means, do it! In my view, however, what ultimately needs to happen for long-term recovery is to replace pulling with is the ability to”tolerate” what you may consider “unacceptable” emotions (anger, grief, excitement), and an”internal” ability to self-soothe. The latter may entail the development of an inner voice that is similar to a supportive and loving parent, a “voice” that challenges your inner critic, and calms you through experiences of fear, rejection, and any other painful or scary feelings.” (Claudia Miles, 2003)

I think all addictions are coping mechanisms.  They help the you deal with overwhelming emotions. I know this is true for me.  As a recovering alcoholic and trichster, I used both addictions to numb myself when confronted with emotions.  Before getting at the addiction behavior, I had to get at the underlying issue: the emotions.  I had to learn to handle my emotions.  To feel my emotions without being overwhelmed or ruled my them.  This has been a process…that is by no means done.  I have come a long way though.  I am learning to use two important words-yes and no.  These help regulate how much I have on my plate.  I used to try and please everyone.  Now, I try to make myself happy.  I don’t think I am selfish, but I have learned to take care of myself.  I think there’s a big difference that I did not understand before.

Click for Complete Article: Viewing TTM as a Behavioral Addiction

Related Articles

By Claudia Miles, MA, MFT, Copyright 2000
Simply substitute hair pulling for alcohol and it is really helpful …which TLC has already done for us:

12 Step Information adapted

for Trichotillomania and

Skin Picking

The Serenity Prayer

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, And the wisdom to know the difference.

The Twelve Steps

1. We admitted we were powerless over trichotillomania – that our lives had become unmanageable.

2. Came to believe that a power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and lives over to the care of God, as we understand God.

4. Made a searching and fearless personal inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being, the exact nature of what we learned in our inventory.

6. Were entirely ready to have God remove all these negative beliefs and behaviors.

7. Humbly asked God to remove our negative beliefs and behaviors.

8. Made a list of all persons we had harmed — including ourselves — and became willing to make amends to them all.

9. Made direct amends wherever possible, except when to do so would injure anyone.

10. Continued to take personal inventory and promptly acted on what we discovered.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood God, praying only for knowledge of God’s will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to other hair pullers, and to practice these principles in all our affairs.

The Twelve Traditions

1. Our common welfare should come first; personal recovery depends upon group unity.

2. For our group purpose there is but one ultimate authority — a loving higher power as expressed to our group conscience. Our leaders are but trusted servants; they do not govern.

3. The only requirement for membership is a desire for recovery from trichotillomania.

4. Each group should remain autonomous except in matters affecting other groups or 12 Step Pickers/Pullers as a whole.

5. Each group has but one primary purpose — to carry its message to other hair pullers who still suffer.

6. 12 Step Pickers/Pullers ought never endorse, finance, or lend the group name to any related facility or outside enterprise, lest problems of money, property and prestige divert us from our primary spiritual aim.

7. 12 Step Pickers/Pullers ought to be fully self-supporting, declining outside contributions.

8. 12 Step Pickers/Pullers should remain forever non–professional, but our service centers may employ special workers.

9. 12 Step Pickers/Pullers as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.

10. 12 Step Pickers/Pullers has no opinion on outside issues; hence the group name ought never be drawn into public controversy.

11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.

12. Anonymity is the spiritual foundation of all our traditions: ever reminding us to place principles before personalities.

The Twelve Promises

I can expect a miraculous change in my life by working the program of 12 Step Pickers/Pullers. As I make an honest effort to use all of the tools of the program…

1. I know a new sense of belonging. The feeling of isolation and loneliness will disappear.

2. I am no longer controlled by my compulsion. I act with courage, integrity and dignity.

3. I know a new freedom.

4. I release myself from shame, worry, and regret about pulling.

5. I know a new love and acceptance of myself. My self-esteem comes from within.

6. I enjoy stable periods of freedom from pulling.

7. I am capable of enjoying life without feeling that I have to hide from others.

8. I learn that it is possible to mend – to heal from the shame and pain of the past, and to learn new behaviors and attitudes that will help prevent my pulling.

9. I acknowledge that I am a unique and precious creation. I treat myself with gentleness, patience and dignity.

10. I trust a guidance I receive from my higher power and come to believe in my own capabilities.

11. I learn to see myself as beautiful, worthy and capable. Whether I am abstinent or not, I enjoy a healthy sense of self-esteem and the love and support of others.

12. I gradually experience serenity, strength, and spiritual growth in my daily life.

Persistence not Perfection


Let’s strengthen those weak muscles!

Just persist until you are successful!

My solace tonight as I persist in my journey to recovery from trich comes from comments of some of the people on the Fairlight Bulletin Board posted on Amanda’s Trichotillomania Guide.

Definition of Success

I just wanted to add another observation to all that has been said about making a commitment to not pulling. Think of it as exercise. When I started walking a couple of months ago, I thought a mile was forever. Now that I’ve been walking regularly, my stamina has increased, and a mile goes by quickly. I can’t run a marathon (yet!), but I am stronger. In the same way, as we practice not pulling, we’re building “muscles” that make it easier not to pull. The first couple of weeks are horrible, but then it gets easier–if you persist. I’ve slipped a couple of times over the last month, but each slip has been of short duration, and my attitude has been, “Well, what’s done is done; let’s get back on track.” Am I pull free? Technically, no; but I have a lot more hair now than I did 6 months ago. Plus I have the strength to stop myself in mid-pull and say, “No, I don’t want to do this anymore.” To add another catch-phrase that has helped me: Pull-free isn’t about perfection; it’s about persistence. So I’ve changed my definition of success. Success no longer means being perfectly pull free; it means being persistently pull free. In other words, I’m in this for the long haul, not just until I succumb to a passing urge. I’m not going to beat myself up for failing, because I will fail. (Last time I checked, I was still human.) I’m not going to let a temporary failure push me into a permanent one. But I am going to push myself always to try harder, because little success build longer successes. I can do this! – (Margaret – Bulletin Board – 14/1/98)

The difference between a “try” and a commitment, to me, is that when a try fails – you give up in despair. A commitment means that even when you slip, you realize that this is important and you keep on trying even though it is very hard. We can tell you that if you persevere – the urges will diminish greatly. It may take 3 weeks to a month to get over the worst of it and even then, occasionally, when you least expect it, the urge will come back. But, truly power IS strength over time. The more you say NO the easier it gets. This has been reported here again and again. If you stay committed to not pulling every day for the rest of your life, you will be successful. Things are very difficult for the first month of going pull-free. It is a wild emotional roller-coaster of a ride as you argue back and forth with yourself about the need to put yourself through this h#%@. One thing is certain, barring a miracle, if you do not stop pulling – then you will keep pulling. It is not going to stop on it’s own. We have had one woman in her 70’s and two in their 60’s posting here. This is not about willpower. For me, and others here have had the same experience, it is like a light switch went on. After reading this board for a while, it just became very clear to me that I was going to have to stop pulling out my hair if I wanted hair. That sounds so simplistic. But it really is what happened and I think it all of the time. If my hand goes to my head – A really loud voice says – HEY! – we don’t do that anymore. Power IS strength over time. The longer I go, the weaker trich’s voice gets and the more booming my own voice gets. It feels great. I wish that I could put it in a bottle and give it to each of you. One way that I got over the first week blues was to come to this board and scream. It was in March and April of 1997. I came here and yelled I HATE HAVING TRICH. LIFE ISN’T FAIR. IT DON’T WANT TO DEAL WITH THIS ANYMORE. It felt good to have a place where everyone really understands just how frustrating trich can be. But, then I went on taking a chance on success. I would tell myself, well if this no-pulling thing doesn’t work out, I can always go back to pulling – but, for once in my life, I want to see if I can really stop. Each time I wanted to give in, I just dug down a little deeper (with a lot of help from my friends here) and pledged to keep going for another day. With each day of success came growing power over my trich. (Marge – Bulletin Board – 14/1/98).

Something from Mike Grant
Hair is a not a good way of measuring progress with ttm. Oftentimes progress is incremental with temporary ups and downs but with an overall trend toward recovery and inner growth. If anyone has ever observed a climber making his or her way to a summit, you will notice their path is not a straight ascent upward. Sometimes a grip is momentary lost, a rock gives way, or other anticipated unplanned event occurs and some ground is temporarily ceded, sometimes more than once, before the climber reaches the summit. Success is based upon anticipating the unplanned and continuing on towards the goal. No one plans a lapse any more than a rock climber plans for a rock to give way. However, the experienced climber knows that is to be expected and plans for the eventuality. The same is true for the individual who has ttm. Those that have been the most successful in the long run are those who accepted the inevitable setback as part of the journey towards recovery and planned for its eventuality. This planning involves emotional preparation to deal with the feelings involved. Like the skilled climber, a successful trichster may have their own safety net to fall back upon should a lapse occur. This safety net could be anything from having a support network to going for a short haircut to limit the pulling before significant damage occurs.