Trichotillomania

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Trichotillomania is a condition that compels people to pull out their hair. It is a psychiatric disorder that usually starts in childhood or adolescence. Trichotillomania can last for several months or many years, and may be worse at some times than others.

What causes trichotillomania?

The causes of trichotillomania are not well understood, but it is likely that genetics and the environment both play a part. People with trichotillomania are also likely to have conditions such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD) or Tourette syndrome.

Trichotillomania symptoms

People with trichotillomania feel a building tension or urge to pull their hair, whether that is the hair on their scalp, on their eyebrows or in their groin. Pulling a hair out temporarily releases the tension, giving a feeling of satisfaction. It can soothe feelings of stress and anxiety, and may even happen without conscious thought.

A session of hair-pulling can be triggered by feelings of stress. But hair-pulling may also happen when people feel relaxed, such as when reading or watching TV.

Although people with the condition, and their family, may think of it as simply a habit, hair-pulling can create obvious bald or thin spots. Embarrassment about their hair loss, and shame about not being able to stop, can lead people to make great efforts to hide it. They may avoid social interactions and activities, or wear a hat, wig or make-up to prevent discovery.

Other physical symptoms can include:

sore and infected skin
permanent damage to skin and hair follicles
hand injury from repetitive use
a hair ball that requires surgical removal (for those who chew or eat the pulled hair)

The physical, emotional and social impacts on the person can be distressing. Many people with trichotillomania experience anxiety and depression.

Trichotillomania diagnosis

Diagnosis is not always straightforward because people may deny they are pulling their hair, or may try to hide it.

Their doctor may refer a person to a psychiatrist (or a child to a paediatric psychiatrist) for diagnosis.

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

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

Trichotillomania treatment

If you have trichotillomania, you can try:

responding to the urge with a different activity, such as squeezing a stress ball
keeping your hair short
putting tape or plasters on your fingertips

If you have a young child with trichotillomania, you can try:

cutting their hair very short
putting gloves or socks on their hands
reminding them to stop when you see them pull their hair

In the case of many young children, it’s a passing phase and they will grow out of it.

Behavioural therapy can be effective, especially a form of (CBT) known as habit reversal training. It can also be combined with other cognitive therapies. These therapies may help someone identify what prompts their hair-pulling and to work out strategies to avoid the behaviour.

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

When to seek help

If you think you or your child may have trichotillomania, it’s a good idea to see your doctor. You can then get treatment to help you overcome the impact of the condition.