Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), also referred to as “hair-pulling disorder,” is a mental disorder classified under Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling.

Hair pulling from the face can result in complete or partial removal of the eyebrows and eyelashes, while hair pulling from the scalp can result in varying degrees of patches of hair loss. The hair pulling and subsequent hair loss results in distress for the person, and can interfere with social and occupational functioning.

For some people, the symptoms of trichotillomania are manageable, but for others, the symptoms can be completely overwhelming.

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Symptoms of Trichotillomania

The primary feature of trichotillomania is recurrent pulling of one’s own hair. Hair pulling can occur in any region of the body in which hair grows; the most common sites include the scalp, eyebrows, and eyelids. Less common areas include facial, pubic, and peri-rectal regions.1

Other symptoms can include the following:

  • Repeated attempts to decrease or stop hair pulling
  • Hair pulling causes distress or impairment in social, occupational, or other areas of functioning
  • An increasing feeling of tension before the hair pulling, or when trying to resist pulling
  • A feeling of relief after pulling
  • Noticeable hair loss
  • Playing with pulled hair, or rubbing it across the face or skin
  • Biting, chewing, or eating pulled hair
  • Pulling certain kinds of hair (certain textures)
  • Hair pulling often occurs in private

Emotional States

Hair pulling may be triggered by or accompanied by a number of emotional states. It can be preceded by anxiety, boredom, stress, or tension, and can result in feelings of gratification, relief, or pleasure following the pulling.2

Hair pulling can also involve varying degrees of awareness.

Focused hair pulling: Some people engage in focused hair pulling with the intention of experiencing tension relief from pulling. In this case, the hair pulling can include specific rituals, including pulling certain types of hair.

Automatic hair pulling: Some people engage in hair pulling without fully realizing it. This can occur when they are bored, watching TV, or engaged in other mindless activities.

Mixed hair pulling: Many people engage in a mix of both behavioral styles.

Many individuals diagnosed with trichotillomania also have other body-focused repetitive behaviors, including skin picking, nail biting, and lip chewing.

Prevalence

The 12-month prevalence for trichotillomania in adults and adolescents is 1-2%, with a female to male ratio of 10:1. Among children, females and males are more equally represented.3

The onset of hair pulling most often coincides with or follows, the onset of puberty. The course of the disease is chronic, though individuals can experience symptoms that wax and wane over time.

There does appear to be a genetic component to trichotillomania. The disorder is more common among individuals with obsessive-compulsive disorder and their first-degree relatives than the general population.4

Risk Factors

  • Age: Onset typically occurs between the ages of 10-13 and can be lifelong
  • Other mental health disorders: People with trichotillomania often have anxiety, depression, or obsessive-compulsive disorder
  • Stress: High-stress levels may trigger trichotillomania for some individuals

When to Seek Help

If you can’t stop pulling your hair and you experience negative repercussions in your social life, school or occupational functioning, or other areas of your life because of it, it’s important to seek help. Trichotillomania won’t go away on its own. It is a mental health disorder that requires treatment.

Treatment of Trichotillomania

Treatment of trichotillomania can be complicated, and most treatment options require time and practice. Individuals often try several strategies to cope with their urges before they find something that works. Try not to get discouraged if symptoms come and go.

  • Habit reversal: This is often the primary treatment of trichotillomania. Individuals learn how to recognize situations where they are likely to pull hair and substitute other behaviors instead. Many people use journaling, alerts, and other strategies to increase awareness of triggers. Instead of pulling hair, a person might substitute behaviors such as; clenching fists or snapping an elastic band on the wrist.
  • Cognitive therapy: This type of therapy can help people explore distorted beliefs related to hair pulling.
  • Self-awareness training: Individuals learn to become more aware of their hair pulling patterns by tracking when they pull and detailing emotions and other important information.
  • Relaxation training: This helps people learn to focus on and calm their central nervous systems in response to stress triggers.
  • Deep breathing training: Learning the proper way to engage in deep breathing helps increase relaxation and focus.
  • Process-oriented therapy: Talk therapy can be effective in helping people explore their triggers and emotions beneath the pulling.
  • Medication: While there are no medications specific to the treatment of trichotillomania, SSRIs and SNRIs can be used to treat some of the accompanying symptoms of anxiety.
  • Family therapy: For children and adolescents, family therapy helps parents learn to better respond to and manage symptoms.
  • Group therapy: Trichotillomania can feel isolating. Groups help people connect with others enduring a similar struggle and provide support for one another.

Some individuals with trichotillomania learn to manage symptoms and triggers with outpatient treatment, while others require more intensive treatment. It’s important to seek help as soon as possible and continue treatment on an ongoing basis.

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Last Updated: Jan 8, 2018