Trichotillomania a True Medical Mystery

March 27, 2008— -- Would you be brave enough to enter a beauty pageant if you had a debilitating secret? If the top of your head — the first thing many people notice — looked frightening to some people?

Twenty-year-old Jena Metts wants to be Miss Kentucky. But she has a secret — she's almost bald.

The most distressing part? She pulls out her hair herself. And though she would dearly love to, she can't stop. She lives with it every minute of the day — pulling out her own hair, strand by strand.

"My last bad pulling spell was probably last week," she said. "I have to really make sure my little short hairs on the top don't stick up."

"I, like, literally have arguments with myself in my head," she said. "I'm like, stop pulling, stop pulling."

It's called trichotillomania, or "trich" for short. Although trich is treated as a psychiatric illness, the latest evidence suggests that it's not a "bad habit" like biting your nails or cracking your knuckles, or even an obsessive compulsive disorder.

Trich may have more in common with Tourette's syndrome, a neurological disorder characterized by repetitive, involuntary movements or vocalizations called "tics."

"Trichotillomania is such a medical mystery because we still know very little about the genetics and biology of it," says Dr. Nancy Keuthen, who heads a trichotillomania clinic in Boston.

According to the Trichotillomania Learning Center (TLC), up to 11 million people in the U.S. suffer from the uncontrollable urge to pull out their own hair, eyebrows, even their eyelashes.

"They may spend hours in front of a mirror in these very odd postures trying to locate that one hair that they know is there that they feel doesn't belong," Keuthen said.

No one understands how to cure trich. The standard treatments, such as drug and behavioral therapy, seem to do little for people like Metts. Over the past 10 years she's seen dozens of psychologists and psychiatrists, and taken a variety of anti-depressants. She says some of them worked in the short term, but none proved a permanent solution.