Explanations of the cause of TTM parallel some of the major
theoretic orientations in the study of human behavior. Psychoanalytic
explanations for hair pulling center on the behavior
as being related to unconscious conflicts. The teenager
described in this report pulled out her hair in the evening
when she was alone in her bedroom and when she was tense
and worried. She had been through a difficult separation of her
parents when she entered adolescence, though her TTM symptoms
began when she was 3 years old. She was anxious, fearful,
and ashamed about her hair pulling, feelings that intensified
the urges to pull her hair.