Overview

Trichotillomania, also known as hair-pulling disorder, is a mental health condition characterized by recurrent, uncontrollable urges to pull out one’s own hair from the scalp, eyebrows, or other parts of the body. Despite attempts to stop, those with trichotillomania often find it impossible to resist these urges. It falls under the category of body-focused repetitive behaviors.

People with this condition may experience noticeable hair loss in patches, leading to significant distress and potential disruptions in their social, educational, and professional lives. They may also take extensive measures to conceal the bald areas.

The severity of trichotillomania can vary; some individuals might manage their symptoms effectively, while others struggle significantly with the emotional impact of their compulsive behaviors. There are various treatment options available that may help lessen or eliminate the compulsion to pull out hair.

Symptoms

The following signs and symptoms of trichotillomania include:

  • Consistently pulling hair from your scalp, eyebrows, or eyelashes, either subconsciously or consciously. You may also occasionally pull hair from other parts of your body.
  • Getting more tension just before or during the attempt to stop pulling out your hair.
  • A pleasant or relieving feeling following hair pulling.
  • Visible signs of hair loss, such as shorter hair or bald spots on your scalp or other body parts. This could include thin or missing eyebrows or eyelashes.
  • Steps for pulling hair such as pulling out particular hair types, using the same procedures each time, or using particular patterns while removing hair.
  • Playing, eating, chewing, or biting hair that was pulled out.
  • Consistently attempting, but failing, to reduce back on the amount of time of hair pulling.
  • Having severe distress or problems relating to pulling out your hair at work, school, or in social situations.

Trichotillomania often coexists with other habits like skin picking, nail biting, or lip chewing. Occasionally, individuals with underlying medical conditions may also exhibit hair removal behaviors involving dolls, pets, or household items. Hair pulling is usually done in private, with intervals ranging from seconds to several hours between episodes. Many affected individuals may strive to keep their condition confidential.

If you find it difficult to cease hair pulling and experience shame or embarrassment due to its effects on your appearance, it’s crucial to seek assistance from a healthcare provider. Trichotillomania is not just a simple habit; it’s a mental health disorder. Without proper treatment, the prospect of recovery is minimal.

Causes

It’s unknown what causes trichotillomania. However, trichotillomania, like many complex disorders, most likely comes from a mix of acquired and genetic factors such as:

  • Genetics: There are some DNA mutations that might induce TTM. More investigation is required to confirm.
  • Modifications in brain chemistry or structure: Individuals diagnosed with TTM frequently exhibit alterations to specific areas of the brain or changes in brain chemistry.
  • Coping mechanism: Many TTM patients say that their condition began following a period of intense stress in their lives. Others claim that they started pulling their hair out of boredom and that it eventually turned into a habit.

Risk factors

Trichotillomania is more likely to occur when certain factors occur:

  • Age: It commonly appears between the ages of 10 and 13 years old, either before or during the early adolescent years. Although hair pulling is a common occurrence in babies, it usually occurs in moderate cases and resolves on its own without medical intervention.
  • Environment: The likelihood of hair pulling is frequently increased by boredom, isolation, and solitude.
  • Family history: Trichotillomania could be due in part to genetics. If you have a close family who suffers from trichotillomania, your chances of developing the disorder may increase.
  • Health conditions: Some people may experience discomfort from skin or hair problems. This might draw their attention to their scalp or cause them to pull hair.
  • Other mental health conditions: Trichotillomania may coexist with other disorders as anxiety, depression, or obsessive-compulsive disorder (OCD).
  • Stress: For certain individuals, extremely stressful situations or events might lead to trichotillomania.

While men are treated for trichotillomania significantly less frequently than women, this difference may be due to women’s tendency to seek medical attention. Both boys and girls have trichotillomania equally often in early life.

Diagnosis

To diagnose trichotillomania (TTM), your healthcare provider will first perform a physical examination, looking for visible signs of hair loss, and inquire about your medical and psychological history, as well as any current circumstances that might be relevant. They may also suggest a consultation with a mental health specialist who has experience treating TTM. Despite its relative simplicity to identify, patients often conceal their condition due to embarrassment or shame, making it challenging for healthcare providers to diagnose TTM through questioning alone.

For a more accurate diagnosis, a healthcare provider might conduct a “punch biopsy,” where a small piece of skin is removed for laboratory analysis. This test not only helps confirm the presence of TTM but also excludes other potential skin conditions that could be causing the hair pulling or loss. This thorough approach ensures that all possible medical and psychological issues related to the disorder are addressed.

Treatment

Many people have found that some treatment options help them stop or significantly decrease hair pulling. These consist of counseling as well as medication.

  • Medicines: Although there are no medications specifically approved for treating trichotillomania, certain medications might help alleviate symptoms like anxiety and despair.
    • Antidepressants: Your healthcare provider might suggest an antidepressant like clomipramine (Anafranil). Tricyclic antidepressants and selective serotonin re-uptake inhibitors, or SSRIs, can occasionally assist in reducing the urge to pull hair.
    • Antipsychotics. These medications support normal brain chemistry. Despite their seemingly singular name, these medications are effective in treating a variety of conditions, such as schizophrenia, bipolar disorder, and dementia.
    • Anticonvulsants: Along with assisting with TTM, these medications are commonly used to treat seizures and other conditions affecting motor function.
    • Nutraceuticals. These are nutritional products that may assist in the treatment of conditions, including supplements containing amino acids.

Consult your healthcare provider about any prescribed medications. One ought to balance the potential advantages of medications against any possible disadvantages.

  • Therapy: The following types of treatment could be beneficial for trichotillomania:
    • Habit reversal training: The primary procedure for treatment for trichotillomania is behavior therapy. You get better at identifying instances in which you’re most likely going to pull out your hair and at replacing those instances with alternative actions. For instance, you may try to resist the temptation by clenching your fists. When you sense the need to pull out your hair, one type of habit reversal training called decoupling includes immediately moving your hand away from your hair and toward another spot. Habit reversal training may be combined with other therapy.
      This type of treatment trains you to break habits like hair pulling by increasing your awareness. Out of all the TTM treatment options, this approach has the highest chances of success.
    • Acceptance and commitment therapy: You can learn to accept the desire to pull your hair without giving in to them with the help of this treatment.
    • Cognitive therapy: You can discover and analyze unrealistic beliefs you may have regarding hair pulling with the use of this treatment. You can get constructive perspectives about your medical condition.
    • Group therapy: Certain kinds of group treatment or support may be helpful for those with TTM.

Treatments for mental health issues including depression, anxiety, or issues with alcohol or drug use, which frequently coexist with trichotillomania, might play a significant role in the course of care.

Doctors who treat this condition