According to the DSM-IV-TR (2000), trichotillomania, or TTM, is the repeated pulling out of one’s hair (from any part of the body).
It is associated with tension prior to pulling out the hair, or when trying to resist pulling the hair, and a feeling of relief when the hair is pulled out. Sometimes the hair is discarded, and other times it is eaten, which can lead to serious medical complications because hair is not easily digested and can form into an intestinal blockage over time.
Although it is not uncommon to find people who have both OCD and TTM (15 to 30 percent of individuals with one of the diagnoses will have the other as well), there are differences between the two disorders.
Individuals with TTM do not pull the hair out in response to an obsessive thought. If that is the reason for the hair pulling, the diagnosis is OCD. Also, there is not typically a set pattern or way to pull the hair out in TTM. It is the removal of the hair that is most important, not how it is removed. If it were OCD, there would be a ritual for it.
Trichotillomania does appear similar to OCD, and, in fact, it is more related to OCD than it is to any of the other anxiety disorders. Exactly how the two are related to each other is being researched, but it appears that people with disorders that involve repeated behaviors, such as TTM, OCD, and skin picking, have shown similarities in brain structure and imaging. There are also certain areas in the brain that show similar activity levels in patients with OCD and TTM.
Further, TTM and OCD both show responses to cognitive behavioral therapy (CBT), and their response to medications that treat obsessions also appear to be similar in some studies, but vastly different in others. This just shows how young we are in our ability to understand, on a chemical or brain-structure level, just how the brain functions.
Further research needs to be done to see just how related TTM and OCD are, but it does appear from the current research that they may be more alike than different.