Several of you have asked about trichotillomania and other related impulse-control problems.
I'll try to answer several questions in this posting, and if I miss some, holler out!
Trichotillomania is the fancy name for "compulsive" hair pulling.
It is not a true compulsion, but rather it is classified as an Impulse-Control Disorder. This means you have an impulse to do something that is so strong that you can't resist it. It often does not cause, and is not caused by, fear or anxiety, making it different from OCD-type compulsions (true compulsions).
However, the urge is just as strong, and it can be made much worse in situations where you're experiencing anxiety or stress. All impulse-comtrol probelms involve an element of pleasure, even if it's also painful or regretful (some people that pull their hair state "it hurts so good!"). Afterward, it's normal to be very embarrassed, ashamed, regretful or downright angry at yourself for "not being able to control yourself." But these problems are just as biochemical as OCD is, and controlling this is NOT just a matter of wanting to badly enough, or trying hard enough.
I'll get to other impulse-control disorders (ICDs) in a minute.
Trich, as it's known in the community, seems to affect mostly women, with 90%+ of the people coming in for treatment being female. BUT, recent studies show that as many as 40% of the people that HAVE trich are men, they just don't come in to get treatment (the reasons why this is true are still open to guessing).
Tricksters (as they call themselves) can pull hair from their head, eyebrows, eyelashes or body hair anywhere. This goes beyond the normal eyebrow-plucking that we do as part of normal grooming in this culture. It seems to occur both at times that one is aware (intent on getting that one hair or lash or brow that is bugging us), and sometimes when one isn't aware (like while watching TV, on the phone, driving, in class, reading, etc., you hand will just wander up to your head and before you realize it, there's a pile of hair on the floor).
People with trich have a very highly developed sense of touch, and can actually tell one hair from another (most of us can't), and may spend minutes to hours searching for "that one" (this is called "grazing" by some). They often also are very aware of the differences in touch of fabrics (to the point that they can't wear certain things or can ONLY wear certain things), and have a sense of perfectionism that expresses itself as "my eyebrows have to be PERFECTLY even (this part is like OCD).
Because of this over- develped sense of touch, and the perfectionism, many people with trich also have another ICD, "compulsive" skin-picking. This is over and above normal pimple-popping, often to the point of doing major damage to the skin.
In both cases, they just can't stop until it feel right/perfect/smooth.
Other types of ICDs include "compulsive" shopping, self-mutilation, lying, nail-biting, knuckle-cracking, spending, gambling and certain sexual behaviors. There is also a type of impulsive temper called Intermittent Explosive Disorder, where the person blows up for the littlest thing, and is very regretful afterward, often not even knowing how they got into such a rage. Some people are afraid that Internet Addiction will be added to this ICD category someday; I hope not.
The same meds (mainly the SSRI class of anti-depressants) as are used for OCD are often helpful for ICDs, but for a smaller percentage of people. There are some other meds that may be helpful based on the notion that doing these impulsive behaviors is addictive because they get the brain to release endorphin, a very soothing but HIGHLY addictive substance.
In essence, you may be getting hooked on your own brain chemistry, and these other meds help block that process. More research needs to be done about this, though.
The behavior therapy approach for all ICDs is about the same, and somewhat different from that for OCD. For OCD, we use Exposure and Response Prevention, asking you to voluntarily expose yourself to some small anxiety-producer, and then prevent the response that you normally use to reduce your anxiety, letting it go away by itself.
With ICDs, we use something called Habit Reversal Training. Here, we take three steps: 1) We ask you to monitor your pulling (or whatever you are doing impulsively) to start to bring all the times into your awareness, and also to learn when you are NOT likely to be pullling (les vulnerable times); 2) We use the less vulnerable situations, if possible, to create what is called a "competing response," something that uses the same muscles that pulling does, so you can't do both at the same time; and 3) We teach realxation techniques like deep muscle relaxation, diaphragmatic breathing (or "belly breathing"), or guided imagery. When put together, what we are doing is trading one paired set (have impluse, will pull) for a new paired set (have impulse, will relax) using the competing response as a tool to help get you across the gap.
This sounds too good to be true, and in truth it is much harder than it sounds. But that is only because you have to practice each step alone until it becomes automatic, and then put them together. But people really do stop pulling/picking/biting etc. And, with a maintenance program of monitoring and being aware of potentially vulnerable situations, this change can be VERY long lasting.
It takes work, just like behavior therapy for anything else. But if you knew you were moving to France, and that you wouldn't be able to communicate there in your native language, you'd take a French class, right? Well, this isn't much harder than taking a French class, since you have homework, reports to the therapist each week, and lots of practice when you're done (while you're in France).
The longer you've had the problem, the more work you have to do to get rid of it, all other things being equal (not everyone has the same strength of impulses, just like everyone's degrees of obsessions are different). But the sooner you start, the better. As for hair pulling in particular, the hair usually grows back in, more so if you've been pulling less time, and more so in some body areas than others. But it usually does grow back, and the feeling of having a full head of hair, not having bald spots to cover up, not having to wear a hat or to wear your hair up all the time is worth the effort (for those of you without trich, covering up these traits can be just as hard, and just as important, as hiding our OCD compulsions, and often even harder!).
If you don't know about the Trichotillomania Learning Center(TLC), their site is www.trich.org and they have lots of information about this.

Dr Hatton