Hair Pulling Syndrome is also called as Trichotillomania. It is a mental disorder with an impulsive action of emotion with an intense urge to pull the hair. In adults it is more common in females. The disease is characterized by patchy loss of hair, emotional and impulsive loss of control over the urge due to repeated habituation and repeated failure to control the condition. The condition has strong association with behavioral abnormality in public and personal life.   

Symptoms

• Patchy loss of hair mainly in scalp- baldness, followed by eyelashes, leg hair, body hairs , pubic hairs etc.
• An intense tension before pulling the hair.
• And a feeling of relief after pulling the hair.
• Playing with the pulled out hair.
• Eating the pulled out hair (trichophagia) or chewing it –leading to pain abdomen due to obstruction (Trichobezar).
• Trying to hide baldness in the public by all means to avoid shame and emotional embarrassment. 

Cause

• The exact etiology is unknown so far. But the research made so far as found potential link between it and the neurotransmitter (an chemical also produced in brain) of brain which is a chemical released during the urge and stress  leading to the impulsive action of pulling the hair.
• Mutations in a gene called SLITRK1 have been linked to Hair Pulling Syndrome as well as to another condition called Tourette syndrome, a neurological disorder that causes a person to make unusual movements and sounds.
• Anxiety
• Depression
• Same condition in relatives is an risk factor  

Diagnosis

It does not have a specific test to diagnose it. The diagnosis is made by

• The patient’s history assessed by a psychiatrist or a psychologist after analyzing the patient’s and relative’s history and symptoms.
• Physical examinations and the signs of repeated pulling the hair
• Ruling out other medical causes of hair loss.

Treatment

The main stay of treatment is by

• Cognitive Behavior Therapy – It teaches people how to become aware that they  are having the problem of Trichotillomania and they are going to pull the hair and to reverse this habit by making them aware of it.
• Acceptance and commitment therapy - It helps people to learn how to accept their hair-pulling urges while at the same time teaching them how to avoid acting on their impulses.
• Medication – when the above therapy is not sufficient then the Psychiatrist prescribes antidepressants and/or antipsychotics.