and robust evidence from high-quality studies is lacking. acetylcysteine treatment stemmed from an understanding of glutamate's role in regulation of impulse control. different medications, depending on the individual, may increase hair pulling. devices technology can be used to augment habit reversal training or behavioral therapy. several mobile apps exist to help log behavior and focus on treatment strategies. there are also wearable devices that track the position of a user's hands. they produce sound or vibrating notifications so that users can track rates of these events over time. prognosis when it occurs in early childhood (before five years of age), the condition is typically self-limiting and intervention is not required. in adults, the onset of trichotillomania may be secondary to underlying psychiatric disturbances, and symptoms are generally more long-term. secondary infections may occur due to picking and scratching, but other complications are rare. individuals with trichotillomania often find that support groups are helpful in living with and overcoming the disorder. epidemiology although no broad-based population epidemiologic studies had been conducted as of 2009, the lifetime prevalence of trichotillomania is estimated to be between 0.6% and 4.0% of the overall population. with a 1% prevalence rate, 2.5 million people in the u.s. may have trichotillomania at some time during their lifetimes. trichotillomania is diagnosed in all age groups; onset is more common during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12–13. among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female. among adults, females typically outnumber males by 3 to 1. "automatic" pulling occurs in approximately three-quarters of adult patients with trichotillomania. history hair pulling was first mentioned by aristotle in the fourth century b.c., was first described in modern literature in 1885, and the term trichotillomania was coined by the french dermatologist françois henri hallopeau in 1889. in 1987, trichotillomania was recognized in the diagnostic and statistical manual of the american psychiatric association, third edition-revised (dsm-iii-r). society and culture support groups and internet sites can provide recommended educational material and help persons with trichotillomania in maintaining a positive attitude and overcoming the fear of being alone with the disorder. media a documentary film exploring trichotillomania, bad hair life, was the 2003 winner of the international health & medical media award for best film in psychiatry and the winner of the 2004 superfest film festival merit award. trichster is a 2016 documentary that follows seven individuals living with trichotillomania, as they navigate the complicated emotions surrounding the disorder, and the effect it has on their daily lives. fiction the trichotillomania of a prominent character is a key plot element in the 1999 novel whatever love means by david baddiel. in the superhero fiction series the boys character ashley barret, portrayed by colby minifie is shown suffering from it. music on the 2017 album, 20s a difficult age by marcus orelias, there is a song called "trichotillomania".