Trichotillomania (TTM) is a disorder characterized by the compulsive urge to pull out one's own hair. The causes are unknown but may be related to stress and anxiety or co-occurrence with other mental disorders. Treatment options are limited as no pharmacological treatments have consistently proven effective. However, some studies suggest recreational activities that reduce stress and anxiety through pleasure, like dance or sports, may help diminish TTM symptoms. Further research is still needed to better understand TTM and develop more effective treatments.

1. Potential Causes and Treatments for Trichotillomania

2. Abstract Trichotillomania (TTM) is a complex disorder that is difficult to treat as few effective therapeutic options exist. The causes of TTM at this point are somewhat unknown and there are not many treatment options. Data on the pharmacological and psychological treatment of TTM is limited because it is a disorder that can be linked to many causes and treatments, and not one specific cause has been singled out. Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior. Overall, the causes and treatment for TTM have not been generalized and the cause vary from person to person.

3. What is Tri chotillomania (TTM)? TTM is a compulsive urge to pull out one's own hair is a disorder leading to noticeable hair loss, distress, and social or functional impairment (Lochner, Simeon, Niehaus, & Stein, 2002). It is often chronic and difficult to treat. SYMPTOMS Many individuals with TTM may not realize they are pulling their hair. Patients state they feel tension prior to hair pulling or a sense of gratification after hair is pulled (Lochner, Simeon, Niehaus, & Stein, 2002). Hair pulling occurs in a "trance-like" state. Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels "just right", or pulling in response to a specific sensation (White Kress, Kelly, & McCormick, 2004).

4. HYPOTHESIS 1 Null Hypothesis 1 Trichotillomania is not correlated to the pre-existence or co-existence of other mental disorders. Alternate Hypothesis 1 Trichotillomania is correlated to the pre-existence or co-existence of other mental disorders.

5. HYPOTHESIS 2 Null Hypothesis 2 Trichotillomania is not correlated to stress and anxiety, and therefore cannot be treated with dance and/or sports therapy that will help release such stress and anxiety. Alternate Hypothesis 2 Since Trichotillomania is correlated to stress and anxiety, it can be treated with recreational activities that will help release the stress and anxiety, such as dance and/or sports therapy that will help release the stress and anxiety.

7. Researchers and clinicians postulated that trauma and post-traumatic stress disorder (PTSD) may be involved in the causes of TTM.

8. One particular study presented the case of an 18 year-old female who presented symptoms associated with several discrete diagnostic syndromes; not only did she have TTM, but she also presented symptoms of obsessive-compulsive disorder, major depression, and anorexia nervosa (Pryor, Martin, & Roch, 1995).

9. Non- Supporting Arguments for Hypothesis 1: TTM is NOT correlated to the pre-existence or co-existence of other mental disorders. In support of the fact that TTM is not correlated to any preexisting mental disorder or to the existence of stress and anxiety, Coetzer (1999) presents a study of women suffering from TTM, where it is stated that TTM is a neurological issue because there was a high imbalance of the neurotransmitters among the women studied. Coetzer (1999) also states how TTM can be classified with obsessive compulsive disorders due to how in both the imbalance of the neurotransmitters affects how the brain controls impulses, and that TTM, as a disorder considered impulsive, cannot be directly linked to other disorders.

10. Supporting Arguments for Hypothesis 2: TTM can be diminished through recreational activities In support of how an alternate recreational activities such as dance, gym or sports could help alleviate TTM, we have Grant (2007) who states that there is no pharmacological treatment for Trichotillomania that has consistently demonstrated effectiveness. He also states that hair pulling for some individuals has a pleasurable quality, and pleasure seeking should be considered as a potential clinical means of defining and treating groups of patients with Trichotillomania

11. Supporting Arguments for Hypothesis 2: TTM can be diminished through recreational activities In Flessner (2009), we can see a study where pulling severity, phenomenology, functional impact, and “focused” and “automatic” pulling styles were studied in women with TTM across a wide age spectrum. “Automatic” pulling refers to pulling occurring primarily out of one’s awareness, while “focused” pulling refers to pulling with a compulsive quality that may include pulling in response to a negative emotional state (e.g., anxiety, stress, anger, etc.), or an intense thought or urge (Flessner, Woods, Franklin, Keuthen, & Piacentini, 2009). These emotions could be released through activities that bring pleasure to the person suffering from TTM.

12. Supporting Arguments for Hypothesis 2: TTM can be diminished through recreational activities Walther (2010) states that trichotillomania (TTM), or chronic hair pulling, is associated with significant levels of distress and impairment. Walter (2010) also presents and suggests ways to decrease these levels of distress are, and some of these ways can be activities (e.g., exercise, recreational activities, indulgence in hobbies, crafts, etc.) where stress is released.

14. When it comes to TTM, there is no pharmacological treatment that has consistently demonstrated effectiveness (Grant, 2007) . This was a common finding among other psychology journals and articles.

15. Supporting Arguments for Hypothesis 2: TTM can be diminished through recreational activities To go against the idea of the recreational therapy proposal, Dia (2008), exposes the case of a teenager that was found pulling her hair, specifically her eyelashes and eyebrows, and she was recommended cognitive behavioral treatment and a numbing cream to be applied to the areas where she would pull even more. A numbing cream was given to her because she described the impulse of pulling provoked by an itching sensation coming from the target areas. The treatment proved to be most successful than any other.

16. Supporting Arguments for Hypothesis 2: TTM can be diminished through recreational activities Jefferys (2008), states that treatment studies using behavioral and pharmacological interventions alone or simultaneously are equivocal. These studies show a sustained and good cessation of hair-plucking. This study states the sole use of the atypical neuroleptic Aripiprazole resulted in an almost definite cessation of hair-plucking. Walther (2010) TTM is associated with significant levels of distress and impairment. He also stated that behavior therapy and clomipramine have moderately reduced TTM symptoms in clinical trials. Walther (2009) states enhancing behavior therapy with techniques designed to address TTM patients' emotional control tendencies (e.g., acceptance-based procedures) represent a promising direction in treating TTM.

18. Second Research Question Regarding the second hypothesis, the potential research question would be: How much does the engagement in recreational activities diminish or control the constant presence of TTM?

19. Findings and Implications There is still much research left to be done do regarding TTM and it could be the case that understanding other pre-existing disorders and using alternative therapy methods, might be able to control TTM. It cannot be exterminated because it seems to be a chronic disorder, but there must be an effective general treatment that can be used by more than one person. I mention this because the literature review shows that TTM treatment is dependent on each case. It can be implied based on literature review that TTM sometimes is the result of other pre-existing mental disorders. One of the main sources of TTM is stress and anxiety (Lochner, Simeon, Niehaus, & Stein, 2002) , so it seems logical for people who suffer from TTM to engage in recreational activities as therapy and part of a more complex treatment.

20. References Blum, N. J., Barone, V. J., & Friman, P. C. (1993). A Simplified Behavioral Treatment for Trichotillomania: Report of Two Cases. Pediatrics , 91(5), 993. Retrieved from EBSCO host . Coetzer, R., Stein, D., & Stein, D. J. (1999). Neuropsychological measures in women with obsessive–compulsive disorder and trichotillomania. Psychiatry & Clinical Neurosciences , 53(3), 413-415. Retrieved from EBSCOhost. Dia, D. A. (2008). "I Cant Stop Pulling My Hair!" Using Numbing Cream as an Adjunct Treatment for Trichotillomania. Health & Social Work , 33(2), 155-158. Retrieved from EBSCO host . Gershuny, B. S., Keuthen, N. J., Gentes, E. L., Russo, A. R., Emmott, E. C., Jameson, M., & ... Jenike, M. A. (2006). Current posttraumatic stress disorder and history of trauma in trichotillomania. Journal of Clinical Psychology , 62(12), 1521-1529. Retrieved from EBSCOhost. t. .

21. References Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., & Piacentini, J. (2009). Cross-Sectional Study of Women with Trichotillomania: A Preliminary Examination of Pulling Styles, Severity, Phenomenology, and Functional Impact. Child Psychiatry & Human Development , 40(1), 153-167. Retrieved from EBSCOhos Jefferys, D., & Burrows, G. (2008). Reversal of trichotillomania with aripiprazole. Depression & Anxiety (1091-4269) , 25(6). Retrieved from EBSCOhost. Lochner, C., Simeon, D., Niehaus, D. H., & Stein, D. J. (2002). Trichotillomania and skin-picking: A phenomenological comparison. Depression & Anxiety (1091-4269) , 15(2), 83-86. Retrieved from EBSCOhost Pryor, T. L., Martin, R. L., & Roch, N. (1995). Obsessive-Compulsive Disorder, Trichotillomania, and Anorexia Nervosa: A Case Report. International Journal of Eating Disorders , 18(4), 375-379. Retrieved from EBSCOhost.

22. References Walther, M. R., Ricketts, E. J., Conelea, C. A., & Woods, D. W. (2010). Recent Advances in the Understanding and Treatment of Trichotillomania. Journal of Cognitive Psychotherapy , 24(1), 46-64. Retrieved from EBSCO host . White Kress, V. E., Kelly, B. L., & McCormick, L. J. (2004). Trichotillomania: Assessment, Diagnosis, and Treatment. Journal of Counseling & Development , 82(2), 185-190. Retrieved from EBSCOhost.