Trichotillomania (Hair-Pulling Disorder)

Overview

Trichotillomania, also called hair-pulling disorder, is a mental health condition in which a person repeatedly pulls out their own hair despite trying to stop. It is one of a group of body-focused repetitive behaviors and is related to the obsessive-compulsive spectrum of conditions.

People often pull from the scalp, eyebrows, or eyelashes, leaving patchy hair loss. The behavior can bring a brief sense of relief or satisfaction but is usually followed by distress and embarrassment, and many people go to great lengths to hide it. Trichotillomania is treatable, and behavioral therapy can help people gain control over the urges.

Symptoms

The core feature is repeated pulling out of one's own hair, but the pattern varies from person to person. Common signs include:

• Recurrent pulling of hair, most often from the scalp, eyebrows, or eyelashes
• Patchy bald spots or thinning hair
• A growing sense of tension before pulling and relief or pleasure during it
• Repeated, unsuccessful attempts to cut down or stop
• Playing with, biting, or sometimes swallowing pulled hair
• Distress, shame, or efforts to hide the hair loss

Pulling may be automatic, done without full awareness, or focused, done deliberately to relieve tension.

Causes

The exact cause is not fully understood, and it likely results from a mix of factors:

• Brain and genetic factors: Differences in how the brain regulates habits and urges, with a tendency to run in families.
• Emotional triggers: Stress, anxiety, boredom, or frustration can prompt pulling, which may serve to soothe or self-regulate.
• Related conditions: It often occurs alongside anxiety, depression, or obsessive-compulsive disorder.

Pulling frequently begins in late childhood or the early teen years and can become a long-term, fluctuating habit.

Risk Factors

• Onset typically in late childhood or early adolescence
• A family history of trichotillomania or related conditions
• Anxiety, depression, or obsessive-compulsive disorder
• High stress or difficulty managing strong emotions
• Other body-focused habits such as skin-picking

Diagnosis

Diagnosis is made by a doctor or mental health professional based on the pattern of behavior and its effects, after ruling out medical causes of hair loss. Evaluation may include:

• A detailed history of the pulling, its triggers, and its impact on daily life
• Examination of the affected areas for the characteristic pattern of hair loss
• Assessment for related conditions such as anxiety, depression, or OCD
• Tests to exclude medical hair-loss causes when the diagnosis is unclear

Treatment

The most effective treatment is a form of behavioral therapy, sometimes combined with medication for related conditions.

• Habit reversal training: The core treatment, which builds awareness of pulling and teaches a competing action to replace it.
• Cognitive behavioral therapy: To identify triggers and develop coping strategies.
• Stimulus control: Practical steps such as keeping hands busy and covering tempting areas.
• Medication: Sometimes used to treat coexisting anxiety, depression, or OCD.
• Support groups: To reduce shame and share strategies.

Prevention

Trichotillomania cannot always be prevented, but flare-ups can be reduced.

• Learn to recognize and manage stress, anxiety, and boredom triggers
• Use habit reversal techniques early before pulling becomes entrenched
• Keep the hands occupied during high-risk activities such as watching television
• Seek help promptly rather than hiding the behavior

When to See a Doctor

See a doctor or mental health professional if you repeatedly pull out your hair, cannot stop despite trying, or feel distressed or embarrassed by the resulting hair loss. Trichotillomania is treatable, and there is no need to manage it alone.

If hair-pulling occurs with thoughts of self-harm or hopelessness, or you are in emotional crisis, contact a mental health crisis line or emergency services right away.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Trichotillomania.
2. Mayo Clinic. Trichotillomania (hair-pulling disorder).
3. American Academy of Dermatology Association. Hair-pulling disorder.
4. National Institute of Mental Health (NIMH).