One of the major problems of trichotillomania, the compulsion to pull out hairs to calm yourself, is that many sufferers are ashamed of what they do and therefore fail to seek help. This makes it difficult to establish how many people are affected by it, but it is thought to be between two and four per cent of the population, albeit to differing degrees.

Despite this, it is little-known and even many medical practictioners are unaware of it. If you see your GP and they seem unsympathetic, you do have other options. You can arrange to see a qualified dermatologist or a trichologist independently.

Many sufferers describe how isolating the condition can be, saying that they feel like only they are afflicted. It can also lead to further stress if the person feels they are causing their family distress through pulling out their hair, leading to a vicious circle.

There are many different triggers for the condition. It can be stress-related or as a result of emotional trauma. The act of pulling out hairs is calming, giving rise to an endorphin release, which can lead to a form of addiction. It is often the case that the hair is pulled out without the person even knowing that they are doing it.

Telogen effluvium is a common cause of hair loss in both men and women. It leads to hairs being shed from across the scalp, rather than in patches and can also affect the body.

Causes of telogen effluvium

Frequently, the cause is physical or hormonal stress or a reaction to medicine that is being taken. It can come about quite suddenly and afflicts people of all ages. In most cases it will tend to resolve in around six months.

How does telogen effluvium affect the hair?

The condition occurs when there is a disruption to the hair’s natural growth cycle. The normal cycle for each hair is a long period of growth that lasts around three years and then a rest period, which is typically around three months.

Ordinarily around 15 per cent of hairs are in the rest phase at any one time. However, stress can cause a far greater percentage to enter that state. Around three months after this, these hairs will be shed as new hairs grow in those follicles. At this point, the hair will once again begin to thicken.

There are many conditions that can lead to hair loss. As well as requiring different forms of treatment, different conditions will also have different causes. Your GP or dermatologist should be able to determine the cause of any hair loss you may be experiencing and will be able to advise you accordingly.

In androgenetic alopecia, the cause of hair loss is dihydrotestosterone, also known as DHT. People who have a lot of the enzyme 5-alpha reductase make more DHT and this in turn causes hair follicles to produce thinner hairs. Ultimately, follicles can cease to produce hairs altogether.

Alopecia areata works rather differently. It is an autoimmune disorder where they body itself attacks the hair follicles with white blood cells. Hair production will slow considerably and there can be no hair grown for months or even years. As the hair follicle is still alive, it is possible that the hair will eventually grow back.

As was mentioned at the start of the article, the important thing to do is to first consult your GP in order that any hair loss condition can be properly diagnosed.

Ordinarily, we lose somewhere between 50 and 100 hairs a day, but if the rate of hair loss goes beyond this, it can be quite distressing and there may be a problem.

Female hair loss is caused for a number of reasons, including as a result of diet, hormones, medication and illness. Furthermore, hair tends to thin as women age as older women have less oestrogen.

Marilyn Sherlock from the Institute of Trichologists says:

“There is always a cause for hair loss, but occasionally it can be something as innocuous as having had a fever. The high temperature kills the hair, but it won’t fall out for about three months.”

“Healthy hair requires all vitamins and minerals and being low in certain ones, especially iron, can lead to thinning because iron is vital for new hair cells. A crash diet can lead to quite dramatic hair loss too.”

Hair can also be lost following pregnancy. While hair loss slows considerably during pregnancy itself, afterwards, the hair which would have been lost during that time is shed all at once. Typically, the hair will recover within a couple of months, although it could take longer.

According to experts, such as Dr Bessam Farjo from the International Society of Hair Restoration Surgery (ISHRS), the hair loss condition traction alopecia may be on the rise, mainly due to the hair extensions sported by a number of celebrities.

Experts believe that many young women are attempting to copy the hairstyles of stars like Naomi Campbell (recently pictured with a bald patch suspected to be a case of traction alopecia), Cheryl Cole and Katie Price.

However, the hair extensions and weaves that celebrities sport can create constant tension and pulling on the scalp, which in turn can cause thinning hair or bald patches. Dr Farjo comments on the recent pictures of supermodel Naomi Campbell, saying:

“We often see this type of hair loss in Afro-Caribbean women as they very commonly wear hair extensions or corn rows. The areas around the hairline are the most prone to permanent damage because the hair in this area is more fragile. The other reason for hair damage in these women is the use of chemicals and heat to straighten the hair. Finally, the use of full hair pieces or wigs can cause friction on the scalp that breaks the hair.”