Trichotillomania, or hairpulling disorder, is marked by the repetitive pulling of one’s own hair.
Trichotillomania, or hairpulling disorder, is a mental health condition that causes a compulsive urge to pull out hair.
The disorder falls under the body-focused repetitive behavior (BFRB) umbrella, along with skin picking and nail-biting disorders.
Long-term pulling may lead to noticeable hair loss on the scalp or face. It can also cause significant distress.
However, trichotillomania is treatable. With therapy and, in some cases, medication, you can reduce or stop hairpulling.
Trichotillomania, or hairpulling disorder, is a mental health condition characterized by the recurrent pulling out of one’s hair.
People with trichotillomania experience increasing tension that is released once they give in to the urge.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), trichotillomania appears in the chapter on Obsessive-Compulsive and Related Disorders, along with hoarding disorder and obsessive-compulsive disorder (OCD).
In a U.S. survey of 10,169 adults,
The disorder often appears in children ages 10 to 13 years old.
In childhood, doctors diagnose trichotillomania as frequently in boys as in girls. But by adulthood, the female-to-male ratio is 4 to 1.
If you have trichotillomania, you may:
- repeatedly pull, pluck, or twist your hair
- have noticeable hair loss
- experience redness or irritation at hair roots
- chew or eat pulled-out hair
Hairpulling can occur wherever there is hair is on the body. But the most common area is the scalp.
About 72.8% of people with trichotillomania report pulling hair from their scalp. The second most common places for pulling are the eyebrows (56.4%) and pubic hair (50.7%).
You may have the urge to pull based on how your hair or scalp feels.
Hairpulling can also happen for emotional reasons. Being bored or anxious, for example, can trigger the behavior.
Many people with trichotillomania pull out their hair without realizing it. Other times, people engage in focused pulling, the conscious pulling of hair that feels irregular or out of place.
Over 20% of people with trichotillomania eat their hair after pulling it out.
People who do this may feel ashamed and hide that they’re doing it from their doctor.
Trichotillomania can cause physical, psychological, and social problems.
Nearly one-third of adults with trichotillomania report a low or very low quality of life.
A 2016 study involving 894 individuals with trichotillomania found that many turn to substances to relieve the negative feelings associated with pulling:
- 6% engage in drug use
- 17.7% use tobacco products
- 14.1% use alcohol
Also, 83% of participants reported anxiety, and 70% reported depression due to pulling.
If you have trichotillomania, you may experience the following physical effects:
- permanent hair loss
- skin infections or lesions
- carpal tunnel syndrome
- gastrointestinal obstruction if you swallow hair
Trichotillomania can also impact your mental health and cause:
- low self-esteem due to hair loss or skin damage
- embarrassment or shame
You may also experience social effects because of trichotillomania-related shame or embarrassment, such as:
- social anxiety or avoidance of social situations
- isolation and withdrawal from family and friends
- lack of pleasure from activities you usually enjoy
- doing poorly at school or work
- avoidance of intimacy
- failure to pursue job interview or career advancement
- avoidance of swimming
Experts don’t know exactly what causes trichotillomania. Like many psychological disorders, it’s likely a combination of genetics and environment.
If you have a family member with trichotillomania, you may be more likely to have the condition.
Research also shows that
- post-traumatic stress disorder (PTSD)
- attention deficit hyperactivity disorder (ADHD)
In addition, some research suggests that people with trichotillomania have higher gray matter density in some regions of the brain.
To diagnose trichotillomania, a doctor will look for the following DSM-5 criteria:
- recurrent hairpulling
- repeated attempts to reduce or stop hairpulling
- hairpulling that can’t be better explained by the symptoms of another disorder, such as OCD
- hair loss not caused by a medical problem
- significant distress in social or work situations
Though your symptoms may vary in severity and fluctuate over time, trichotillomania is chronic. Doctors usually treat the condition with cognitive behavioral therapy (CBT) called habit reversal training. Habit reversal training teaches people to replace hairpulling with another less harmful action.
For example, you might focus on using a fidget toy or stress ball instead of pulling your hair.
Treatment may also involve keeping track of hairpulling in a journal and identifying your triggers, which might occur when watching TV or lying in bed.
Medication may also help.
Doctors typically prescribe selective serotonin reuptake inhibitors (SSRIs) or clomipramine, a tricyclic antidepressant, for treating trichotillomania.
They may also prescribe:
Because this condition can cause shame and embarrassment, many people find it tough to discuss it with a doctor.
A study of 1,048 people with trichotillomania found that only 39.5% sought treatment from a therapist, and 27.3% sought treatment from a psychiatrist.
Some people don’t seek treatment because they believe medical or mental health professionals don’t know much about the disorder.
If someone you love has trichotillomania, here are a few things you can do to help:
- Collect various types of brushes for them to touch and pick at. This may include hairbrushes, toothbrushes, nail brushes, and makeup brushes.
- Don’t shame someone for hairpulling. It’s important not to yell or make demands, nor yank your loved one’s hand away. This can cause anxiety or resentment and encourage them to hide the behavior.
- Suggest replacing the behavior with a fidget toy. Some people find it helpful to occupy their hands with drawing, origami, or knitting activities. Another option is to pull out the threads on loosely woven cloth.
- Set up a mirror in typical pulling areas, such as near the TV. This acts as a gentle reminder for those who tend to pull without thinking about it.
- Consider buying a technological bracelet for BFRBs. These gently alert someone when they start to pull.
If you or a loved one has a hairpulling habit, consider reaching out to a trusted healthcare professional to discuss your treatment options.
It may also be a good idea to read about the disorder as much as possible.
Also, several online support groups and websites have information about BFRBs and coping strategies.
The TLC Foundation for Body-Focused Repetitive Behaviors offers extensive information on trichotillomania, skin-picking, and nail-biting disorders. It also features personal stories from people who have trichotillomania.
You’re not alone, and trichotillomania is treatable. You might find CBT or medication helpful.