The underlying cause for the urge to pull in many people diagnosed with trichotillomania is neurotransmitter imbalance. There are many possible causes for this underlying imbalance, but stress of some sort often initiates the process and will cause an increase in the urge to pull once a neurotransmitter imbalance is present.
The body has many mechanisms to deal with stress, but one of the main players is your adrenal glands. The adrenal glands are your ‘fight-or-flight’ organ that either helps you prepare for battle or to get out of dodge as fast as possible. The adrenal glands do this by regulating several chemical messengers, including cortisol, dehydroepiandrosterone (DHEA), norepinephrine (noradrenaline) and epinephrine (adrenaline).
Norepinephrine (noradrenaline) and epinephrine (adrenaline) are neurotransmitters called catecholamines. An imbalance between serotonin and the catecholamines can create numerous symptoms, including the urge to pull. Therefore, stressful events most likely cause an increase in the urge to pull in those with trichotillomania by causing or exacerbating the imbalance between serotonin and the catecholamines (dopamine, norepinephrine and epinephrine).
Reestablishing proper neurotransmitter function will not only help eliminate the urge to pull; by establishing optimal neurotransmitter function, a person can also improve their reaction to stress and lessen the impact that stress has on their health. Not only that, it will act synergistically with other therapies designed to lessen the impact that stress has on those with trichotillomania, including deep breathing, meditation, mindfulness and cognitive behavioral changes. It does so by lessening the surge of adrenaline that normally comes along with stressful events, allowing a person with trichotillomania to feel more in control and better able to function well under and after stressful events.