People with trichotillomania (we also call it "trich" – pronounced like "trick" – or TTM) generally pull hair from their heads, eyelashes, or eyebrows, although some pull from their legs, arms, or pubic areas. Some people just throw away the hair, but many people "play" with it after they pull. They might, for instance, roll the hair, between their fingertips, rub or touch the hair against their face or skin, or look at the pulled hair very closely. Others bite or swallow the hair. A person may do one, two, or all of these things once hair has been pulled. Everyone's hair pulling behavior is unique.

Since we strongly believe that knowledge is power, we want you to be knowledgeable regarding trichotillomania. Here is some background information that is important for you to be aware of:

1. Researchers estimate that approximately 3% of the population suffers from trichotillomania. Most of those who seek treatment are girls or women; however, there is evidence that a significant percentage of people who pull their hair are males.

2. Most people with trichotillomania have their first pulling episode when they are between the ages of 9 and 14 – around puberty. In some cases, however, the onset of TTM does not occur until late adolescence or adulthood.

3. In some cases the habit can begin as early as infancy, where touching, stroking, twirling, and tugging on hair may occur as part of the normal tactile exploration of the environment. In some cases hair is actually pulled out. Most babies and young children outgrow this behavior, but for some, hair pulling becomes a habit that can persist for many years.

4. Once established, trichotillomania can quickly become an extremely powerful habit. It often entails certain specific behavioral patterns, such as playing with or biting the hairs or follicles. Over time, the severity of symptoms may wax and wane, and may be seasonal in nature.

5. Unfortunately, no "cure" for trichotillomania has yet been discovered, nor is there any one "magic bullet" that will work consistently. However, the good news is that with the use of good problem solving skills and proper management, people with trichotillomania can decrease, and in many cases even eliminate, pulling. From our own experience, we know that the approach detailed in this book can be extremely effective in teaching those management skills.