For the longer answer on the subject note that there is a quite specific definition of what qualifies as trich, according to the DSM-IV.
The impression given in that document is that all of these conditions must be present before a person can be classified as a trichster. This is a confusing definition, in part because of the negative connotations of "pleasure and gratification" which are sometimes present but which are often accompanied by serious distress during the act of pulling because part of the puller's mind is begging for the puller to stop doing it. Also, there is confusion because there is debate among people more intimately connected with the disorder as to whether it is more closely related to Obsessive Compulsive Disorders than it is to Impulse Control Disorders. Also, psychological professionals don't tend to have high success rates in treating the disorder, which indicates at least that this is a poorly understood condition.
And on and on. All this debate is enough to make a person, well, you know. For this reason, on the bulletin board we follow the general idea that if you pull your hair and it bothers you, you are "one of us," in the best possible sense of the phrase. Also if you pick your skin or do anything else which led you to believe that this board would be more helpful to you than anything else you have found on the web, you are welcome.
This is a reasonable approach since many credible professionals and many trichsters themselves (the true experts in this poorly understood condition) believe that many of these disorders or "habits" are related. There are many similarities between hair-pulling, compulsive hair-cutting, head-scratching, nail-biting, scab-picking, blemish-picking, etc., and many times a person with trich will do more than one of the above. Many times a person with trich will have family members who do one or more of the above, or who exhibit other OCD- or ICD-like traits.
Therefore, we will count you as "one of us" for as long as you feel a bond with our community.
What causes trich? (Why is there so much confusion?)
There is credible evidence that different things trigger pulling.
For a long time many thought the existence of trich implied that the trichster was an incest victim. Later it was considered a possibility that excessive moving during childhood could bring it on. Some said moving to a new community could trigger it. Later still it was allowed that any kind of trauma might cause trich. One person on the board started pulling after the Northridge earthquake.
Some people seem to have succumbed to OCD-like and BDD-like impulses (obsessive compulsive disorder or body dysmorphic disorder).
The trance-like state in which many pull could be induced by ADD-like impulses (attention deficit disorder).
Some, having modified their diet to avoid sugar and found that their trich urges have disappeared, might have become trichsters as an allergic reaction to sugar and the yeast colonies that it causes to grow in the body (such yeast naturally occurring in everyone but some people seeming hyper-sensitive to it).
Others seem to be responding to other allergins, such as pollen or pets.
Some have found their urges disappear or are minimized when they take vitamins or minerals. One person reported improvement when he started a course of thyroid medication.
Such positive responses to external physical changes suggest that there might have been an external physical cause.
Also it seems possible that viruses can trigger trich.
And then there is the issue of heredity. Trich doesn't usually appear in more than one member of a family but frequently many members of the same family will have what seem to be related disorders such as nail-biting, body-picking, OCD's, AD(H)D, eating disorders, alcoholism, etc. This is addressed ifurther in the next section.
Before I go on, I need to note that if certain ones of the above are the cause of the hair-pulling behavior, then according to the DSM-IV definition of trich, the hair-puller doesn't technically have trich. The hair-puller "merely" has an allergy or a thyroid problem, or something like that. What is overlooked in the DSM definition is that whatever caused a person to start pulling, there are powerful forces working inside the person to maintain this very distinctive behavior which almost takes on a life of its own whatever happened to trigger it the first time. A girl may start at age 12 when she finds stress relief from pulling but at age 30 the woman is a totally different person. The hair-pulling behavior has reinforced itself and has now been causing stress for nearly 18 years. The more important question becomes:
As mentioned above, there is evidence for heredity.
However, even if heredity is a factor, there are at least two big arguments against thinking there is some sort of special genetic link here. First, it is possible that genes aren't involved at all but rather that certain families haven't learned the coping skills needed to protect them from such disorders. So they can't pass the coping skills on to their children. So a new generation of children is susceptible to the frustrating disorders, disorders which become worse when other aspects of life are frustrating, creating a hard-to-break cycle.
The second argument against any special sort of hereditary factor is that it seems very possible that all human beings have the potential to get trich or something like it (so it isn't "special" or rare). Think about the number of people you have ever seen twirling their hair, or even pulling out a few during times of extreme stress. Think about the people who tug on their lashes to loosen the ones which are nearly ready to come out naturally. Think about the nail-biters and lip-biters you've seen.
There are a small set of nervous, grooming-like behaviors which seem to be done by most people in the world but a wide continuum of how intense different people's involvement in these behaviors can be.
There is reason to believe that these behavior are permanently wired into the brain's circuitry. If that were not so, then what explains the amazing similarity between the secret rituals which trichsters perform with their hair during and after pulling? Almost all trichsters have adopted these rituals on their own (with variations based mostly on what type of hair is pulled). The rituals are so hard to explain to someone who doesn't share the problem that usually the trichster never mentions it to anyone until they first read another trichster confess to the same thing. Since, no one has ever shown or told the trichster about these rituals, the only explanation I can see is that it is instinctive.
It makes sense for the behaviors to have been developed and preserved on an instinctual level because if no one in a community has the tendency to routinely check their body and hair for abnormalities, then many things could go undiscovered until too late, from lice infestations to a splinter that causes a person to die of blood-poisoning.
And since some of the necessary checking and picking behaviors are distasteful (to trichsters as well as to nontrichsters) it makes sense that on the same primitive level there would be a reward built in to encourage the activity, to make the person keep prodding for what is wrong when a "normal" person would say, "Ouch! that hurt, I'm not going to do that again!" That reward would be the intense gratification which trichsters often feel when pulling out hairs, especially those with large roots.
No, this aspect of this instinctual behavior does not make sense, but instinct only needs to be useful sometimes to justify its continued existence.
No, not everyone focusses on their hair to anywhere near the degree of a trichster. No, not everyone who ever starts focussing on their hair feels the degree of gratification which reinforces the trichster's behavior and eventually causes it to spiral out of control.
So it might still be interesting from an academic or scientific point of view to find out why some people develop it and others do not? However, as trich is indeed a poorly understood condition and as I have already spend much time in basically academic discussion, it seems that the most constructive thing would be to now summarize how all of the preceding considerations work into a strategy to free the trichster from the hair-pulling behavior.
Summary of the foregoing discussions and strategy for treating trich:
Yes, we may have different origins of our disorder. In some cases those initial causes could still be factors in why we pull. However, in most cases, once the pulling circuitry has been accessed, another phenomenon has been set off. In many of those cases the causal factors can be entirely eliminated (may have already been entirely eliminated) and yet the built-in rewards for hair-pulling may trap the person in the frustrating, rewarding, painful, pleasurable habit of pulling (or picking or whatever similar behavior a person on the board might have). So, a three-pronged attack needs to be made:
I am biased because I would be considered a "lumper" in the language of the article below, which I have excerpted from a post on the newsgroup alt.support.ocd, however I do think it is a very good explanation. It is written Catherine Yronwode who is not a trichster and does not have OCD; her interest in the subject is explained briefly in the article. (I did get her permission to quote it.)
[omitted the article to which Catherine was responding]
In the study of taxonomy (the naming and classification of plants, animals, or other things) there are two factions, "lumpers" and "splitters." Lumpers tend to see closely related animals or plants as being likely the SAME species and may account for any small differences in appearance as population drift and thus designate them as sub-species. Splitters tend to see closely related animals or plants as likely DIFFERENT species and may magnnify any small differences in appearance and thus designate them as separate species.
It's the same with the classification of diseases. Such "sub-species" of OCD as Trichotillomania (hair pulling), Body Dismorphic Disorder (obsessions with defects of the body, especially bodily symmetry), Orynchophagia (nail biting), and the like were long ago designated as "separate species" or different mental disorders. Folks like Jim, who follow the "official" diagnostic standards, tend to see them that way, as distinct and separate disorder, based on the way the patient "presents."
Folks like me -- who only started learning about this on my own less than a year ago and submerged myself in new research papers with no regard to the history of how these disorders were previously classified -- tend to see them all as the "same species," as nothing more than various aspects of OCD. I don't know much about how patoients "present" because i am not a doctor. I am a hobby-genetics student, though, and i am interested in the underlying pattern of molecular abnormality that could give rise to these obsessive and compulsive behaviours. When i look at the broad picture from a genetics viewpoint, not only BDD and Trich and Orynch look like sub-species of OCD, but even TS looks a lot like a form of OCD to me, because in my opinion, the "vocal tics" of TS are differentiated from the "ritualized compulsions" of OCD for the sole and silly reason that the body part that is used to carry out the compulsion -- the vocal chords rather than the hands, for instance -- is different. So i am speculating that further genetic investigation wil reveal that a series of closely-linked gene defects are affecting a certain set of closely-linked receoptors in the brain.
As the years go by and research piles up, the "lumpers" seem to be gaining ground in the field of OCD/TS reserach. One reason for this shift in opinion is that the same drugs (SSRIs) help all of these supposedly different disorders. Another reason for the shift is that in doing family studies as a preliminary to genetic research, it has become apparent that TS, OCD, BDD, ADD, Trich, and Orynch all run TOGETHER in families.
Just something to think about...time will tell the full story.
catherine yronwode
Other disorders reported by trichsters on the board: ADD, ADHD, Asperger's syndrome (reported by family members of children with this disorder), bipolor disorder, body dysmorphic disorder (BDD), body picking, clinicial depression, compulsive hair-cutting, eating disorders (such as anorexia, bulemia and compulsive eating), fibromyalgia, grinding teeth ("bruxism"?), nail-biting (orynchophagia, orynch), post-traumatic stress syndrome, obsessive compulsive disorder (OCD), restless leg syndrome, self-cutting and substance abuse. There are probably still others. At first I asked readers for ideas about connections. I probably won't be updating this site any time soon though. I've moved on though from trich, not necessarily from all pulling, but from worrying about it. The coping strategies I learned because of my trich are being applied to other areas of my life now. Weaknesses can be made into strengths. Cherish that idea. :-)
Who gets trich? How many trichsters are there in the world?
Short answer: we've had posters from many countries, and probably every genetic, ethnic, and cultural heritage you can think to ask about. Hair color doesn't seem to be a determining factor. It has been said that there are two common times of onset, infancy and puberty; however, on the board it has been reported to have started in college or during a pregnancy and even during or after menopause. Though people posting to the board and people reporting it to their doctors seem to be predominantly women, men seem to get it in fairly large numbers and can suffer acute distress from it. [I think that Amanda is starting a page where men can leave email addresses and possibly start a loose network of male pullers. We appreciate the men who stay around for awhile and put up with discussions which might seem exclusively feminine.]
Many sources suggest that 8 million people in the U.S. have trich, which is approximately 1/32 of the U.S. population. More conservative estimates have placed the incidence of trich as being as low as 1 in 200 women in such stressful environments as college with even lower occurences for the rest of the population.
I, a college student and very open about my trich, am never surprised to meet another trichster. Additionally, I've met family members of trichsters and several people who pull out their hair but aren't techically trichsters because they aren't bothered by it (they only do it on rare occasions and get over it quickly without psychological trauma). Finally, I've met people than I can count who were embarrassed by such things as compulsively and painfully scratching their heads or biting their cheeks or things like that, things which they felt alone in but mentioned to me because they thought that as a compulsive hair-puller I would understand.