Trichotillomania (Hair-Pulling Disorder)

Trichotillomania is a hair-pulling disorder with symptoms that may vary from person to person. Some common signs and symptoms may include:

• Frequently pulling out hair, usually from the scalp, eyebrows, or eyelashes, but occasionally from other parts of the body
• Experiencing a growing sense of stress before pulling hair or when trying to resist the urge to pull
• Experiencing a sense of pleasure or relief after hair has been removed

Excessive hair-pulling can cause various physical and emotional results, such as:

• Hair loss and bald spots
• Itching and skin irritation
• Localized skin infections
• Chronic pain
• Blepharitis or eyelid inflammation (from pulling out eyelashes)

Individuals with trichotillomania may often try to hide their hair-pulling habits. They might wear hats, scarves, or makeup to conceal hair loss or avoid social situations where their hair-pulling behavior might be noticed. 

To be diagnosed with trichotillomania, individuals must show recurrent pulling out of hair that negatively affects their quality of life and can’t be explained by other mental health disorders or medical conditions. In addition, the individual must have repeatedly attempted to stop the hair-pulling. 

As with many mental health conditions, the severity and prevalence of symptoms like hair loss can vary among persons with this disorder and may also change over time. In some cases, people with trichotillomania may develop an associated behavior known as trichophagia or the consumption of hair. This behavior can lead to the formation of a trichobezoar, or hairball, in the digestive system, which may cause further complications like nausea, vomiting, and stomach pain. Individuals who learn to recognize the signs of trichotillomania and seek professional help may be able to reduce the lasting effects of this disorder.

While the exact cause of trichotillomania is still not well understood, researchers believe that several components play a role, including genetic, environmental, and psychological factors.

Some common influences that may increase the risk of developing trichotillomania include:

• Genetics: A family history of trichotillomania or other obsessive-compulsive-related disorders may increase the likelihood of an individual developing the condition.
• Environment: Stressful life events, family conflicts, or other environmental stressors may incite hair-pulling behaviors in some individuals.
• Psychology: Trichotillomania is often associated with other mental health conditions, such as anxiety, depression, and obsessive-compulsive disorder (OCD).²

Trichotillomania typically begins during puberty and is more common in females than males. The onset of hair-pulling behaviors may align with hormonal changes or increased stress during adolescence. Although the condition can persist into adulthood, some individuals may experience decreased symptoms as they age.

In some cases, trichotillomania may be related to trauma³ or other adverse experiences. For those individuals, specific triggers⁴ can cause a sudden urge to pull hair, leading to a cycle of hair-pulling and emotional distress.

The standard treatments for trichotillomania, in which people can't resist urges to pull out hair from their body,  involve therapy and medication to reduce or stop the urge to pull hair. 

Medication

There is no specific medication approved for trichotillomania. However, some people may benefit from medications that manage symptoms. For example, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) may reduce anxiety and OCD-related symptoms that contribute to hair-pulling. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

In some cases, alternative treatments like hypnotherapy or biofeedback may be considered. Hypnotherapy involves using methods of relaxation and suggestion to help individuals gain control over their hair-pulling urges. In contrast, biofeedback involves monitoring physiological responses like muscle tension and heart rate while learning various relaxation techniques to manage hair-pulling. These treatments may not work for everyone. Talk with a healthcare professional before trying alternative therapies.

Self-care

Individuals living with trichotillomania may practice self-care measures to complement treatment and promote overall well-being, such as the following: 

• Develop healthy coping mechanisms: Engage in activities that may reduce stress and anxiety, such as exercise, meditation, or journaling.
• Connect with support groups: Joining a support group or online community can provide emotional support, encouragement, and helpful tips from others who understand the struggles of living with trichotillomania.
• Create a safe environment: Make changes to the home or workplace that reduce the opportunity to pull hair and encourage healthier behaviors. For example, wear gloves, keep hair covered, or place reminders near mirrors.
• Be patient and compassionate: Accept that setbacks may occur and remember that progress takes time. Instead of focusing on the setbacks, focus on the improvements made along the way.

While living with trichotillomania can be challenging, a combination of therapy, medication, and self-care strategies may help individuals reduce or stop hair-pulling behaviors.

Several resources are available to educate, support, and treat people with trichotillomania. As therapy may be a helpful option for managing this condition, online therapy platforms like BetterHelp may serve as a potential resource for finding support. These platforms can connect clients with providers from home via phone, video, or live chat sessions. 

Numerous mental health organizations also focus on providing assistance to those coping with trichotillomania. The TLC Foundation for Body-Focused Repetitive Behaviors offers education, support, and outreach programs to support individuals and their families. Their initiatives aim to improve the quality of life for those who experience these habits, advocate for scientific research, and spread awareness about trichotillomania and related disorders.

Support groups are another potential resource for people with trichotillomania. Connecting with others who understand and experience the same challenges can help individuals learn new coping strategies and realize they are not alone in their journey. These groups might be found on the websites of mental health organizations or by contacting local healthcare professionals to inquire about groups in the area.

Various studies have investigated how trichotillomania develops and which treatments may be effective for people with this disorder. One area of research has explored the effectiveness of acceptance-enhanced behavior therapy (AEBT) and psychoeducation plus supportive therapy (PST). 

A recent study found that individuals were more likely to recover from the disorder with AEBT compared to PST. The improvement seen in AEBT was linked to changes in psychological flexibility, even when considering other factors like anxiety and depression. The study’s results could impact how future providers treat this condition and guide further research in this area.

Another area of research delves into the neurological aspects of trichotillomania, which may help researchers identify potential causes and treatment targets. One study found differences in brain structure between individuals with trichotillomania and healthy controls, suggesting that changes in brain function may influence how hair-pulling behaviors arise. As more studies are done, new insights and treatments may be discovered to help manage the disorder.

Below are several statistics on trichotillomania:

• Trichotillomania is found in 1.7% of people, with a balanced distribution across all ethnic groups, regardless of education or income. Those with the condition find it distressing, averaging 5.1 out of 7 on a distress scale, and 79% of those with trichotillomania also have at least one other mental health condition. 
• A study of over 2,000 college students indicated that six out of 1000 individuals may develop trichotillomania during their lifetime.
• Trichotillomania is often believed to affect women more than men. However, other studies have called this idea into question, as one study involving 791 university students showed the rates did not significantly differ between men and women, with 3.5% of men and 4.1% of women experiencing it. 
• Approximately 35% of individuals living with trichotillomania seek treatment for their condition, taking steps toward a healthier life.