Table of ContentsView AllTable of ContentsSymptomsComplicationsRisk FactorsDiagnosisTreatmentOutlook
Table of ContentsView All
View All
Table of Contents
Symptoms
Complications
Risk Factors
Diagnosis
Treatment
Outlook
Trichotillomania, also known as hair-pulling disorder, is a mental health condition that causes recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body. Trichotillomania is classified under the category of “related disorders” in theDiagnostic and Statistical Manual of Mental Disorders, 5th Edition(DSM-5).
Trichotillomania often results in the complete or partial removal of hair from the body, most commonly from the scalp and face. The symptoms and effects can be severe but are often manageable with treatment.
This article will cover the symptoms and risk factors of trichotillomania, as well as how it is diagnosed and treated.
Also Known AsHair-pulling disorderPathological hair-pullingTTMTric
Also Known As
Hair-pulling disorderPathological hair-pullingTTMTric
Jessica Olah / Verywell
Symptoms of Trichotillomania Hair-Pulling
People with hair-pulling disorder feel an intense urge to pull their hair out and experience growing tension until they do.After pulling their hair out, they feel relieved. A person with trichotillomania may also pull their hair out because of stress. Sometimes, people with hair-pulling disorder don’t even realize that they’re pulling their hair.
Behaviors associated with hair-pulling disorder include:
For people with hair-pulling disorder, these behaviors negatively affect their daily lives.
Studies have shown that people living with trichotillomania are likely to engage in episodic or frequent episodes of eating hair (trichophagia). About 5%–20% of people with trichotillomania also have trichophagia.
Guilt and shame often follow the hair-pulling. People with trichotillomania will often pull out their hair in private if possible.
Types of Hair Most Often Pulled OutScalp (the most common site)BeardEyelashesEyebrowsArmpitsChestPubic area
Types of Hair Most Often Pulled Out
Scalp (the most common site)BeardEyelashesEyebrowsArmpitsChestPubic area
The hair-pulling behavior of people living with trichotillomania can be classified as focused, automatic, or mixed. These subtypes specify how aware the person is of their hair-pulling:
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Complications of Trichotillomania
Trichotillomania comes with many physical and emotional complications, which are usually a result of excessive hair-pulling.
Physical complications of hair-pulling disorder include:
Emotional complications include:
Common Comorbidities of TrichotillomaniaPeople with hair-pulling disorder are likely to have another mental health condition, including:Major depressive disorderGeneralized anxiety disorderPost-traumatic stress disorderAlcohol use disorder
Common Comorbidities of Trichotillomania
People with hair-pulling disorder are likely to have another mental health condition, including:Major depressive disorderGeneralized anxiety disorderPost-traumatic stress disorderAlcohol use disorder
People with hair-pulling disorder are likely to have another mental health condition, including:
Additional complications include social isolation from hiding to pull out hair and financial effects from being unable to continue with normal daily activities like going to work.
Risk Factors for Trichotillomania
It’s not clear what causes hair-pulling disorder, but experts have identified a few risk factors for why some people may develop trichotillomania:
The average age of onset for trichotillomania is often between 10 and 13 years old, but it can start younger.Once it starts, hair-pulling disorder has the potential to be lifelong. People who are prone to stress or have high levels of stress in their lives are at a higher risk of developing trichotillomania.
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How Is Trichotillomania Diagnosed?
A mental health professional can diagnose trichotillomania based on a clinical evaluation, a person’s health history, and testing to rule out other causes of hair loss.
The DSM-5 criteria for hair-pulling disorder include the following:
If you or a loved one are struggling with hair-pulling disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.
If you or a loved one are struggling with hair-pulling disorder, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.
For more mental health resources, see ourNational Helpline Database.
Trichotillomania is often misdiagnosed as OCD.While the repetitive and compulsory actions of hair-pulling disorder can look like those in OCD, they are different.
When differentiating trichotillomania from OCD, providers will screen for repetitive hair pulling and other repetitive habits, as well as evaluate a person for symptoms that are specific to OCD.
Common questions providers ask when screening for OCD include:
Providers also need to differentiate hair-pulling disorder fromalopecia areata, a medical condition that causes hair to fall out in small patches. Atrichoscopy, medical history, and scalp biopsy can all be used to rule out alopecia as a cause of hair loss.
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How Trichotillomania Hair-Pulling Is Treated
While hair-pulling disorder cannot be cured, it can be managed with therapy. There are various options for treating trichotillomania. Even though hair-pulling disorder is classified as an obsessive-compulsive disorder, it is treated differently.
Habit Reversal Therapy
Habit reversal therapy (HRT) tries to help a person learn to recognize and change patterns that lead to hair pulling. The goal is to replace hair pulling with a more helpful behavior.
A few strategies used in HRT include:
Cognitive Behavioral Therapy
Another form of therapy to treat trichotillomania is cognitive behavioral therapy (CBT). CBT goes hand in hand with HRT but is a deeper dive into the thoughts behind a person’s hair-pulling.
In CBT, people practice mindfulness and challenge limiting beliefs. They also learn to identify the factors that lead to hair-pulling as well as the repercussions of the behavior.
Group Therapy
Trichotillomania can feel isolating. If you are diagnosed with the condition, it can help to know that you’re not alone. Group therapy can be a safe, accepting place for someone with hair-pulling disorder to connect with other people who understand what they’re going through.
The benefits of group therapy sessions can include:
Medications
No drug can treat or cure trichotillomania. Some medications, while not specifically approved for treating hair-pulling disorder, can be prescribed to help people cope with the condition.
Some common medications used to treat trichotillomania include:
Wearables
Researchers have been exploring whether wearable devices can help people with hair-pulling disorder manage their symptoms.
The devices, often used together with mindfulness therapy, help a person become more aware of their hair-pulling behaviors. For example, the wrist wearable may vibrate when the person starts to pull their hair to serve as an awareness reminder and give them a chance to divert their attention or stop the behavior.
One of the most popular wearables for hair-pulling disorder isHabitAware’s Keen2 bracelet, which costs about $150.
The bracelets can also be used to help people manage other body-focused repetitive behaviors (BFRBs), likeskin picking.
Medications for Anxiety and Depression
Things to Try When You Feel the Urge to Pull Your Hair
While you need to work with a mental health professional if you have trichotillomania, there are some things you can do when you feel the urge to pull your hair or steps you can take to prevent yourself from pulling your hair. For example, to make it harder to pull out your hair, you can:
To resist the urge to pull your hair out, you can:
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Outlook for Trichotillomania
There is no specific cure for hair-pulling disorder, but people can learn how to manage the symptoms and reduce the negative effects that trichotillomania has on their lives.
Research suggests that trichotillomania often gets worse over time, particularly if it starts in childhood.However, studies have also shown that when kids and adolescents get some form of treatment, their hair-pulling symptoms can often get better or at least become easier to manage. Increased awareness as people get older also helps them learn to manage the condition.
Summary
Trichotillomania or hair-pulling disorder is a complex mental health condition that can be distressing and isolating to experience. Before diagnosing the condition, a provider needs to rule out other causes of hair loss and make sure that a person meets the criteria for trichotillomania. Once diagnosed, a person can explore treatment options for hair-pulling disorder like therapy and medication.
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25 Sources
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