What is Trichotillomania (Hair-Pulling Disorder)?

Trichotillomania (Hair-Pulling Disorder) is the uncontrollable urge to pull out your hair. Individuals with trichotillomania often pull hair from their scalp, eyelashes, and eyebrows. Trichotillomania is an impulse control disorder. Sometimes the eyelashes of someone with a trichotillomania disorder are called trichotillomania eyelashes.

While those with the condition recognize the urge to pull hair, they find it difficult or impossible to control the urge. Other common terms or names for trichotillomania include “hair pulling disorder” and “pulling out hair disorder.”

Symptoms

All of the trichotillomania symptoms involve hair pulling or the consequences of hair pulling. Sometimes individuals with the condition pull hair from themselves. Other times, they pull hair from pets, dolls, or blankets.

Common signs of trichotillomania:

• Compulsively pulling hair from eyebrows, eyelashes, and scalp.
• Noticeable patches of missing hair.
• Social problems related to hair pulling.
• Work, career, or professional problems related to hair pulling.
• School issues related to hair pulling.
• Personal distress over hair pulling.
• Fiddling with pulled out hair.
• Biting pulled out hair.
• Chewing pulled out hair.
• Eating pulled out hair.
• Internal tension that builds to an overwhelming desire to pull out hair.
• Surge of tension right before they pull out hair.
• Surge of tension if they try to resist pulling out their hair.
• Temporary feeling of relief from tension immediately after pulling out their hair.
• Multiple failed attempts to stop pulling out their hair.
• Rituals or sequences of behaviors associated with hair pulling.
• Personal inclination toward pulling specific types or textures of hair.

Individuals with trichotillomania might also repeatedly pick their skin, bite their lips, or chew their fingernails.

Causes

There are no known trichotillomania causes. However, there are several risk factors that increase the likelihood that someone might develop the condition.

Risk Factors

There are several risk factors that increase the likelihood of developing trichotillomania.

Risk factors include:

• Age—The onset of trichotillomania is often in the pre-teen to early teen years between 10 and 13. This is a recognized major developmental period for many people.
• Gender—In childhood, an equal number of males and females seek treatment for the condition. However, over a lifetime, a higher percentage of females seek treatment.
• Family History—Researchers believe genetics play some role in developing the disorder. Someone with a close relative with trichotillomania might be at greater risk.
• Stress—Significant stress may precede onset of the disorder. Prolonged exposure to stressful situations or events might place someone at higher risk.
• Other Conditions—Disorders associated with trichotillomania include Post Traumatic Stress Disorder (PTSD), anxiety, depression, and obsessive-compulsive disorder (OCD). Trichotillomania is sometimes referred to as trichotillomania OCD.

Diagnosis

There is no specific trichotillomania test or exam that will definitively determine if you have the condition. However, your doctor will likely explore certain areas of your life to help make a potential diagnosis.

Common factors to explore include:

• Amount of hair loss you experience.
• Life stressors you might experience.
• Your personal experience with hair loss.
• Possible causes of hair loss.
• Assessing potential mental health conditions.
• Assessing potential physical health conditions.
• Reviewing the diagnostic criteria for trichotillomania in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is a resource published and updated by the American Psychiatric Association.

Your doctor may refer you to a psychiatrist or psychologist for further evaluation and testing.

Treatment & Recovery

Trichotillomania treatment usually falls into two main categories: therapy and medication. There is no known trichotillomania cure.

Therapy

In the context of trichotillomania, therapy typically refers to cognitive therapy, acceptance therapy, or behavioral therapy. You may also receive a combination of therapies, such as cognitive-behavioral therapy.

Cognitive therapy helps you identify and replace limiting or problematic beliefs. Acceptance therapy helps you accept the desire to pull your hair without acting on the desire. Behavioral therapy allows you to develop a set of skills to address your condition. Skills include identifying symptoms, identifying stressors, increasing awareness of physical hair pulling, and replacing the habit of hair pulling with alternative behaviors.

Medication

Trichotillomania medication helps relieve and manage anxiety, depression, stress, and OCD symptoms. Medication is considered a temporary reduction of symptoms, not a cure. Ongoing medication is often needed to maintain remission from the disorder. When patients stop medication, the symptoms of trichotillomania usually return.

Complications

Certain complications of trichotillomania may negatively impact your life.

Common complications include:

• Skin and Hair Injury—You may experience temporary or permanent damage to your body. Some individuals with the disorder experience scarring, bleeding, and infections.
• Emotional Discomfort— You may feel guilt, shame, powerlessness, anger, loneliness, low self-esteem, or depression because of your condition. You may also experience self-hatred that motivates unhealthy alcohol and drug use.
• Social and Professional Problems—Individuals with the condition often avoid situations where their disorder might be discovered by friends, family, and co-workers. Therefore, these individuals may stay away from social outings and close relationships.
• Hairballs—When someone consumes enough hair over several years, the hair may accumulate in their digestive tract. Hairballs can result in discomfort, vomiting, intestinal issues, and sometimes even fatality.

If you or someone you love experiences any of the signs and symptoms of trichotillomania, a behavioral care specialist at Baptist Health may be able to help.