Our brains can give rise to all manner of odd psychiatric problems, but one of the strangest is trichotillomania better known as hair-pulling. The uncontrollable desire to yank out one's hair may seem like a freaky sideshow diagnosis, but the disorder is actually not so uncommon, affecting perhaps 2 million American adults over 22. Exact numbers are hard to come by since people with the condition often hide it sometimes they don't even appear in public because of their embarrassing, mangy bald spots. There is no approved treatment.
But a paper published this week in the prestigious Archives of General Psychiatry offers a simple new hope for trichotillomania sufferers. In a small trial of 50 hair pullers, more than half of those who took an over-the-counter antioxidant called N-acetylcysteine, which is available in pill form at mainstream stores like GNC and Vitamin Shoppe, had improvement of symptoms after 12 weeks, compared with 16% of those taking a placebo.
If the findings bear out, they may herald a potential new treatment for an age-old condition. As psychiatric symptoms go, hair-pulling is among the earliest recorded. According to Dr. Jon Grant, a trichotillomania expert at the University of Minnesota School of Medicine and the lead author of the new paper, Hippocrates himself said that in order to test whether patients were faking their illness, doctors must ask whether they are pulling out their hair. The behavior is so commonly associated with distress that the stock phrase to describe a stressful situation is that it causes you to tear your hair out.
We seem wired to attack our hair under traumatic conditions, possibly because forcibly extracting hair is painful; it can divert attention from stress to the more immediate matter of how to solve a pressing problem. For chronic hair pullers, that diversion turns into addictive psychological relief. Some people with trichotillomania pull out hairs not only from their heads but also from their pubic areas and armpits; as many as 20% eat their hair; a small minority pull other people's hairs. "Many say it's not painful but more of a sense of just a tug, one that provides a calming feeling," says Grant. "Some of these people are not even aware they are pulling their hair. Their spouses will say, 'Stop that,' and they are not even aware they have a clump of hair on their lap."
Grant theorizes that trichotillomania may be a kind of grooming irregularity that falls into the obsessive-compulsive family of disorders. "Some parrots pull out all their feathers," he says. "Some mice pull out all their fur."
That may explain why the antioxidant N-acetylcysteine can help prevent it. The compound is thought to work by reducing the synaptic release of a neurotransmitter called glutamate. As Grant told me, glutamate is the communication chemical that "tells the brain, 'Do it! Do it! Do it! Do it!' And the rest of the brain can be overwhelmed by this drive state." Reduce glutamate and you may reduce the drive state. Previous studies have suggested the supplement may also reduce urges to use cocaine and to gamble.
Likewise, in Grant's 12-week study, those compulsive hair pullers who were randomly assigned to receive 1,200 to 2,400 milligrams of N-acetylcysteine a day experienced a 40% reduction in scores on a test designed to measure trichotillomania. Unfortunately the patients did not report a substantial improvement in quality of life, but Grant believes that may be because three months is too soon for unsightly bald spots to have grown back.
Currently, most patients with trichotillomania are treated with psychotherapy or antidepressants, including selective serotonin-reuptake inhibitors (SSRIs), like Prozac. But in recent years, four studies that looked at SSRIs in the treatment of trichotillomania showed they are not effective in relieving the condition. (Indeed, there is an emerging debate about the limitations of SSRIs, which received enormous media exposure in the '90s and have become the go-to drug to treat not only depression but, with varying success, anxiety, nicotine addiction, body-image problems, bipolar disorder, psychosis and a host of other mental disorders.) While there's been less research on drugs that manipulate glutamate perhaps because it can be modulated fairly easily with nonprescription amino acids like N-acetylcysteine the new study suggests the neurotransmitter may play a key role not only in the rare condition of hair-pulling but also in other obsessive-compulsive problems.