What is trichotillomania?

Trichotillomania is a condition where you feel the urge to pull out your hair. This is typically followed by a temporary feeling of relief. It’s a mental health issue that usually starts in childhood or adolescence.

Trichotillomania can last for several months or many years. It may be worse at some times than others.

What are the symptoms of trichotillomania?

You may feel a building tension or urge to pull your hair. This may include:

• hair on your scalp
• hair on your eyebrows
• your eyelashes
• hair in your groin area

You may also have other habits like:

• nail biting
• skin picking
• lip biting

Pulling hair out can temporarily release tension you may be feeling. It can also make tense feelings worse.

If you have trichotillomania, you may pull your hair out to try and find relief from stress and anxiety. Hair pulling often gives a short-term sense of relief. This is why the urge to pull continues.

Hair-pulling can also happen when you feel relaxed, such as when you are watching TV. You may also pull your hair out without thinking about it. This is more of a mindless habit.

The physical, emotional and social impacts of trichotillomania can be distressing.

Hair-pulling can create obvious bald or thin spots. This can make you feel embarrassed about your hair loss, and about not being able to stop.

You may make great efforts to hide your hair loss. You may wear hats, wigs or make-up to avoid drawing attention to bald spots. You may also find yourself avoiding social interactions and activities.

Other physical symptoms can include:

• sore and infected skin
• hand injuries from repetitive use
• a hair ball that requires surgical removal (for those who chew or eat the pulled hair)

What causes trichotillomania?

The causes of trichotillomania are not well understood. It’s likely that your genetics and the environment both play a part.

Many people with trichotillomania experience other mental health issues, like:

• anxiety
• depression
• obsessive-compulsive disorder (OCD)

When should I see my doctor?

See your doctor if you think you may have trichotillomania.

Your doctor can also refer you to a mental health professional for more support, such as a psychiatrist.

If you think you have trichotillomania, you may find it difficult to seek help. Remember, help and treatments are available to help you overcome the impacts of trichotillomania.

How is trichotillomania diagnosed?

Diagnosis of trichotillomania is not always straightforward. You may find yourself hiding or denying that you are pulling your hair. Be as honest as you can with your doctor, so they can best support you.

The condition fits the medical definition if it meets 4 specific criteria:

1. The pulling results in hair loss.
2. There is evidence that the person has tried to stop.
3. The condition can’t be explained better by another medical condition such as body dysmorphic disorder.
4. The pulling is causing significant distress.

Your doctor may refer you to a mental health professional such a psychiatrist for diagnosis. Your child can be diagnosed by a paediatrician.

How is trichotillomania treated?

There are different treatments that can help you manage and overcome trichotillomania.

Behavioural therapies, such as cognitive behaviour therapy (CBT), can help. These therapies may help you identify what triggers you to pull your hair and to work out strategies to stop the behaviour.

Self-care at home

If you have trichotillomania, you can try:

• squeezing a stress ball when you have the urge to pull your hair
• keeping your hair short
• wearing a tight-fitting hat like a beanie
• putting tape or band aids on your fingertips
• exercise

If you have a young child with trichotillomania, try to direct them to other activities instead. Try toys that involve pulling or fidgeting.

Medicines

There are some medicines that might be helpful, but there is little conclusive research in the area. Your doctor will be able to discuss this with you.

Can trichotillomania be prevented?

Prevention of trichotillomania may depend on what is causing it. Treatment may help you recover from trichotillomania and prevent the condition from coming back.

Complications of trichotillomania

If trichotillomania is left untreated, hair pulling can cause permanent damage to your skin and hair follicles.

If trichotillomania is associated with anxiety or another mental health issue, this can cause problems later in life.

Resources and support

SANE Australia and the Anxiety Recovery Centre Victoria (ARCVic) have more information about trichotillomania. ARCVic can also connect you to online support groups.

The Sydney Children’s Hospital Network has a child-focused fact sheet on trichotillomania, as well as management tips.

For advice and to get connected to local mental health services, call Medicare Mental Health on 1800 595 212. Check the operating times.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.