Trichotillomania: Symptoms, Causes, and Treatments for Hair Pulling Disorder
Key takeaways:
Trichotillomania (hair pulling disorder) is a debilitating condition in which people pull out hair from the scalp, face, and other parts of the body.
Unless people disclose hair pulling, trichotillomania can be difficult to diagnose since there are other medical conditions that cause similar types of hair loss.
Treatment for trichotillomania includes therapy, such as habit reversal therapy, and medications. Many people need treatment for years to help manage the condition.
Table of contents
Trichotillomania (hair pulling disorder) is a chronic condition in which people feel a compulsion to pull out their own hair using their hands or instruments like tweezers. In the long term, hair pulling disorder can lead to scarring and permanent hair loss.
But people with hair pulling disorder also face a near constant urge to pull their hair and that mounting tension is only relieved when they pull the hair out. They may also be uncomfortable with the effects of hair pulling like missing eyebrows, eyelashes, and bald spots.
Many people with trichotillomania want to stop pulling their hair, but they don’t always know where to turn for help. There are treatments for trichotillomania that can help people manage their symptoms. Here’s a look at trichotillomania and options for treatment.
Search and compare options
What causes hair pulling disorder (trichotillomania)?
It’s not clear why some people develop hair pulling disorder. Researchers believe a combination of things causes people to develop the condition.
Some studies show that people with trichotillomania have differences in parts of their brains. But it’s not clear whether these differences are present before or after people develop the condition. Other studies have looked at whether people with trichotillomania have different responses to brain chemicals, like serotonin. Yet other researchers have looked at people’s responses to stress and how that may trigger and reinforce hair pulling behaviors.
It’s possible that all these things play a role in whether someone develops hair pulling behaviors. It’s also possible that there are other causes that scientists haven’t yet discovered.
Is trichotillomania associated with other medical conditions?
Yes. Nearly everyone with hair pulling disorders also have a diagnosis or symptoms of other conditions, including:
Mood disorders
Anxiety disorders
Substance use disorders
Eating disorders
Personality disorders in adults
Disruptive behavior disorders in teens or children
It’s important to know that trichotillomania is listed under “obsessive-compulsive disorder and related symptoms” in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). But trichotillomania and obsessive-compulsive disorder (OCD) are not the same thing. People typically have different symptoms and experiences with OCD.
Read more like this
Explore these related articles, suggested for readers like you.
What are the symptoms of trichotillomania?
Hair loss is the major physical symptom of trichotillomania.
People often pull hair on their scalp and this leads to areas of hair thinning or baldness. The areas can have different sizes and shapes depending on where the pulling happens. At first, hair will start to grow back so the areas can change in location and size. Over time, hair will stop growing back and the hair loss becomes permanent.
Some people pull their eyelashes, which can cause bare spots along the eyelids and potentially eye irritation since the eyelashes help protect the eyes from dirt and debris. Other people pull hair from their eyebrows, pubic area, and other parts of their body. This also leads to bald spots.
Hair loss can be easy for other people to miss, especially if it’s an area covered by clothing. People helping their loved ones through trichotillomania treatment are often careful to note any hair changes for signs of pulling.
The emotional symptoms of trichotillomania may be invisible but are just as important, and often more distressing for people living with trichotillomania. People can experience a wide range of emotions and feelings, including:
A growing, uncomfortable compulsion to pull their hair
Trouble tolerating emotional stress, which can increase the compulsion to pull hair
Fear of judgment from others about their hair pulling
Shame about their hair pulling
A sense of relief following hair pulling
How serious is hair pulling disorder?
Trichotillomania is a serious condition. It can lead to permanent hair loss and scarring, especially if people use instruments like tweezers and scissors for pulling.
About 1 in 5 people also eat the hair they pull. Over time this can lead to trichobezoars (hairball), which can block the intestines. This is a serious medical condition that requires surgery to remove the hairball.
Hair pulling disorder can also lead to avoiding school and work because of the embarrassment related to patches of hair loss. Over time, this can lead to poor school performance and trouble holding down a job.
People may also avoid social situations for the same reasons. Social isolation and loneliness can affect people’s long-term emotional and physical well-being.
How do you distinguish between trichotillomania and other types of hair loss?
All a healthcare professional needs to confirm a diagnosis of trichotillomania is your story. If you’re willing to disclose your feelings and hair-pulling patterns, your healthcare professional can give you a diagnosis and offer you treatment.
But it can actually be quite tricky to diagnose someone with trichotillomania if they’re not willing to disclose that they’re pulling their hair. There are many reasons for hair loss and nearly all of them are more common than hair pulling disorders.
At first, a healthcare professional might diagnose someone with one of these other, more common causes of hair loss. But when the hair loss doesn’t get better with treatment, it’s a sign that something else is going on.
Often, a dermatologist helps diagnose trichotillomania. They may use different methods to diagnose the condition including:
Hair count
Weighing shed hair
Pull tests
Trichograms
Blood tests
Skin cultures
Skin biopsy
Skin biopsy is the most invasive option and involves removing a small piece of skin from the area of hair loss. The tissue is then examined under a microscope, which will show evidence of trauma to the hair follicles. This confirms a diagnosis of trichotillomania.
How do you treat hair pulling disorder?
Treatment for hair pulling disorder depends on your goals. Some people want to stop pulling their hair altogether. Others are just searching for ways to pull less.
Treatment usually involves a mix of medications and therapy. Experts recommend that people always engage in therapy if they want to try medications. But you can use therapy as a treatment without medication if that’s your preference.
Therapy is the cornerstone of trichotillomania treatment. Therapy usually includes habit reversal therapy and stimulus control. Habit reversal therapy focuses on encouraging awareness of situations, emotions, and physical feelings that can trigger hair pulling. People are also taught how to replace hair pulling with another action and how to use techniques like relaxation and meditation.
Medication options include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline. Sometimes, N-acetylcysteine is also used to help treat hair pulling disorder.
The bottom line
Trichotillomania or hair pulling disorder is a condition where people pull out their hair in response to a compulsion. It can lead to long-term hair loss, scarring, and emotional distress. Treatment for trichotillomania includes habit reversal therapy and medications.
Why trust our experts?
References
Grant, J. E. (2019). Trichotillomania (hair pulling disorder). Indian Journal of Psychiatry.
Harrison, J. P., et al. (2012). Pediatric trichotillomania. Current Psychiatry Reports.
Jain, N., et al. (2013). Trichoscopy in alopecias: Diagnosis simplified. International Journal of Trichology.
Janeczek, M., et al. (2018). The potential uses of N-acetylcysteine in dermatology: A review. Journal of Clinical and Aesthetic Dermatology.
MedlinePlus. (2022). Trichotillomania.
Melo, D. F., et al. (2021). Trichotillomania: What do we know so far? Skin Appendage Disorders.
Pereyra, A. D., et al. (2023). Trichotillomania. StatPearls.
Woods, D. W., et al. (2014). Diagnosis, evaluation, and management of trichotillomania. Psychiatric Clinics of North America.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
