What is trichotillomania?
Trichotillomania involves an irresistible urge to pull out hair. This behavior occurs to the point of noticeable hair loss. The most common areas for hair pulling are the scalp, eyelashes and eyebrows, but the person may pull out hair anywhere on the body.
In children, trichotillomania occurs equally in males and females. In adults, it is more common in women than in men.
Symptoms and Causes
What causes trichotillomania?
The exact cause of trichotillomania is not yet known, but it appears to involve both biological and behavioral factors. The risk of developing trichotillomania is slightly higher in people who have relatives with the disorder, suggesting that a tendency for the disorder to be inherited. In some cases, people with trichotillomania also have other disorders such as depression or obsessive-compulsive disorder.
What are the symptoms of trichotillomania?
A person with trichotillomania cannot control or resist the urge to pull out his or her body hair. Other symptoms that might occur with this disorder include the following:
- A sense of tension before pulling hair or when trying to resist the urge to pull hair
- A feeling of relief, satisfaction and/or pleasure after acting on the impulse to pull hair
- Presence of bare patches where the hair has been pulled out
- Presence of other associated behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on the hair, or eating hair (called trichophagia)
Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.
Diagnosis and Tests
How is trichotillomania diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. There are no tests—such as X-rays or blood tests—to diagnose trichotillomania, although tests might be used to rule out any medical cause for the hair loss.
If trichotillomania is suspected, the doctor might refer the person to a psychiatrist or psychologist (healthcare professionals who are specially trained to diagnose and treat mental illnesses). Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an impulse control disorder.
Management and Treatment
How is trichotillomania treated?
The main treatment approach for trichotillomania is a type of behavior therapy called habit reversal training. With this approach, a person with trichotillomania first learns to identify when and where he or she has the urge to pull hair. This technique also teaches relaxation as a way to reduce some of the tension associated with the urge, and helps the person develop a different behavior to use when the urge to pull hair occurs. This new activity, called a competing response, might be as simple as making a fist with the hand that is used to pull out the hair. Some therapists also use cognitive therapy as a way to address any distorted thinking that might be adding to the stress that triggers the behavior.
In addition, medication might be used as part of the treatment program. A type of antidepressant medication called selective serotonin reuptake inhibitors (SSRIs) might be useful in helping to curb very intense urges.
What are the complications of trichotillomania?
Infection, skin damage and permanent hair loss are possible complications of trichotillomania. The hair loss and skin damage can lead to problems with self-esteem and body image, and can have a negative impact on work and relationships. In extreme cases, some people might avoid social situations in order to hide the resulting hair loss.
People who engage in trichophagia (eating hair) are at risk for forming trichobezoars, or balls of hair, in the stomach or small intestines. Trichobezoars can lead to pain, nausea and vomiting, bleeding, blockages, and other serious gastrointestinal problems.
Can trichotillomania be prevented?
There is no known way to prevent trichotillomania. However, getting treatment as soon as symptoms appear might help decrease any possible disruption to the person’s life, family and friendships. Stress reduction also might help, since stress often triggers the hair pulling behavior.
Outlook / Prognosis
What is the outlook for people with trichotillomania?
Children often recover completely from trichotillomania. In adults, however, the disorder tends to be chronic (ongoing) and harder to treat.