What is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania, human impulse behavioral problem,hair pulling disorder

You might ask, what is trichotillomania (pronounced (trick-o-till-o-may-nia)? It’s when someone has an uncontrollable or sometimes unconscious urge to pull their hair out at the root.  Some claim that they can control the action while others have an overpowering urge to pull out their hair.  This type of behaviour is not common and can interfere with their everyday life.  As it’s not widely publicised, it can make victims feel lonely and, at times, confused.

Every primate has a grooming instinct, and humans are no exception.  When a human (or any other primate) is emotionally disturbed, the grooming process goes into overdrive as a form of self-soothing.

Facts about Hair Pulling Disorder

Victims of trichotillomania pull hair from various parts of their body.  Hair may be torn out of arms, legs, feet, pubic area, and even eyebrows and eyelashes.  Inevitably, bald patches will appear. The average age group affected by trichotillomania is between 9 and 13 years old.

Far from an occasional occurrence, people with trichotillomania are compelled to pull or twist their hair until it comes out.  This can lead to hair breakage and bald patches.

Although trichotillomania is effectively self-inflicted and somewhat painful, it is not consciously self-harm.  It’s on the same level as nail-biting, meaning a sufferer does not choose or want to pull out their hair; it is a compulsion and a form of mental illness which needs to be treated as such.

A victim of trichotillomania usually pulls hair from one or two locations.  For example, someone may pull hair from a particular area of the scalp and leg.  However, this is not limited to one or two areas.  In some cases, the way the hair is pulled is random. This can happen spontaneously because the sufferer is tired of pulling from one spot or trying to stop the thinning of the hair.  At this present time, there are three types of hair pulling, focused, automatic and mixed.

Focused hair pulling: Some people pull their hair out with the intention of experiencing the tension relief from pulling.  With focused hair pulling, the pulling of the hair can sometimes include only pulling out certain types of hair.

Automatic hair pulling: Some people pull their hair without fully realising what they are doing.  This can occur because they’re bored, watching television or engaged in other mindless activities.

Mixed hair pulling: This type of hair pulling is a mix of both behavioural styles above.

Many individuals diagnosed with trichotillomania may also chew their lips bite their nails or pick their skin.

Woman pulling her hair

Symptoms and signs of Trichotillomania

The most obvious symptom is noticeable hair loss in the area where you are pulling it out, such as thinned or bald areas on the scalp or body.  Other signs and symptoms can include:

  • Biting or chewing the pulled-out hair
  • A sense of pleasure and/or relief once the hair has been pulled out
  • An increasing feeling of tension before pulling out the hair or when you try to resist doing it
  • Constantly pulling your hair out
  • Trying repeatedly to decrease the hair-pulling or trying to do it less
  • Feeling distressed or uncomfortable in social situations
  • Sparse eyelashes or patchy eyebrows
  • Bald or thin patches on the scalp

What is the cause of Trichotillomania?

The pulling of hair may be triggered by a number of emotional states and there appears to be a link between stress, anxiety and anger levels and the frequency of hair-pulling.  It is unclear though whether anxiety and depression lead to the hair-pulling or if the hair-pulling causes anxiety or depression, or both.  The disorder is more common with individuals who suffer from obsessive-compulsive disorder (OCD).

Read more about OCD here.


An evaluation to determine if you have Trichotillomania will include:

  • Asking you questions about your hair loss
  • Looking to see how much hair you have lost
  • Trying to identify any physical or mental health problems you may be experiencing
  • Testing to eliminate other possible causes of your hair pulling

How to treat Trichotillomania

At present, there doesn’t exist a universally effective treatment for trichotillomania.  However, some common treatment includes:

  • Anti-depressants: Although there isn’t a specific medication for the treatment of trichotillomania, a doctor can prescribe something to treat the symptoms of anxiety.
  • Cognitive behaviour therapy CBTThe aim of CBT is to focus on how your thoughts and attitudes affect your feelings and behaviour, and teach you coping skills for dealing with different problems.
  • Support groups or alternative medicine i.e. hypnosis, diet change or medication.
  • Family therapy: This type of therapy helps the parents learn to respond positively to and manage the symptoms of young children and adolescents.
  • Group therapy: Trichotillomania can make you feel very isolated.  By joining a support group you get to meet with other sufferers with similar experiences who can relate to how you are feeling.
  • Habit reversal training: You learn how to recognise the situations where you are more likely to pull your hair and then taught to substitute it with different behaviour.
  • Relaxation training: You will be taught to focus
  • Self-awareness training: Individuals learn to identify their triggers when hair pulling patterns starts by keeping a diary of when they pull their hair and how they were feeling at that time.
  • Deep breathing exercises: With some practice-changing how you breathe can make a real difference to how you are feeling.

Seeking help is the first step to treating the hair pulling.  After being examined by your doctor or a dermatologist, he or she may refer you to a mental health professional.

Risk factors of Trichotillomania

Those afflicted with trichotillomania are at risk of other problems occurring, such as:

  • Trichophagia: This is when suffers digest the hair they are pulling.  As the body cannot digest the hair, it can build up in the stomach and, in some rare cases, this can prove fatal if the hair gets causes a blockage or gets into the intestines.  It can also cause weight loss, nausea and vomiting.
  • Infection: In some cases, the hair-pulling can get out of control.  When this happens, the hair puller might start bleeding and the open wounds are prone to bacteria.
  • Carpal tunnel syndrome: Because of the repetitive use of their hands while pulling hair, the sufferer may develop carpal tunnel syndrome.
  • Emotional distress: Many of those with trichotillomania can feel shame and embarrassment.  They may experience depression, low self-esteem and turn to alcohol because of their condition.

How do I stop pulling my hair out?

  • Put lotion on your hands so that it’s hard to grasp the hair.
  • Put post-it notes in places where you normally pull your hair with inspirational quotes about stopping hair pulling.
  • If you have a pet, stroke it as sometimes running your hands through your pet’s fur can give the same sensation that you are looking.
  • Imagine how happier you would feel without trichotillomania in your life.
  • Take a nice relaxing bath to ease any anxiety.
  • Keep a daily journal documenting how you are feeling.
  • Make yourself busy.
  • Take pictures of your bald spots and put them where you can see them.
  • Tell your family and friends to tell you to stop if you see you pulling.
  • Speak to a professional.

In closing

Trichotillomania is a much misunderstood and under-studied disorder.  Although it may not seem very serious to some, it can have a major negative impact on your life.  More research needs to be done to close the gaps in our understanding of this condition.  Although it can be distressing to both sufferer and their families, with proper support it can be managed and hopefully stopped.

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