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Trichotillomania is a compulsive urge to pull and/or twist of the hair until it breaks off, resulting in noticeable hair loss.  The hair may be lost in round patches or diffusely across the scalp.  It is a type of compulsive behaviour and its causes are not clearly understood, although symptoms usually begin before the age of 17, with women almost four times likely to be affected than men.  It may affect as much as 4% of the population.  The action of pulling on the hair over a long period of time results in the gradual shrinking of the hair follicle and so the hairs produced become finer and finer and permanently damaged if not treated.

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