Trichotillomania

Trichotillomania (TTM) is a mental health condition where you repeatedly and frequently pull out your own hair. It leads to hair loss and emotional challenges. This condition is related to obsessive-compulsive disorder (OCD).

There are different reasons why you may pull out your hair. Sometimes, you feel a strong urge, and pulling brings relief. This is called focused pulling. Other times, it happens without thinking, like when you’re bored, stressed or touching your hair out of habit. This is called automatic pulling.

Trichotillomania (pronounced "trick-oh-till-oh-main-ee-uh") is uncommon. Episodes often happen in private and may be brief, but the effects can be noticeable.

A healthcare provider can help you manage symptoms.

Trichotillomania symptoms

The main symptom of trichotillomania is pulling out your own hair. You might do it on purpose — for example, when hair feels or looks out of place. Other times, you might do it without realizing.

Common symptoms include:

• Repeatedly pulling out hair, leading to noticeable hair loss
• Trying to stop pulling but feeling unable to resist the urge
• Feeling anxious or stressed before pulling out hair and relief or pleasure once hair is out
• Pulling out hair in patterns or only specific areas, like eyebrows or eyelashes
• Chewing on or eating pulled out hair
• Feeling stressed or embarrassed, or having trouble at work, at school or in relationships because of hair pulling

Behaviors like picking your skin or biting your nails may happen with TTM.

Trichotillomania causes

The exact cause of trichotillomania isn’t known. Experts believe several factors may play a role, including:

• Brain chemistry and structure: Differences in brain areas that control emotions, habits and impulse control, and changes in chemicals (like serotonin, dopamine and glutamate) may play a role.
• Genetics: Some research suggests that changes in certain genes, like the ones involved in how brain cells communicate, may make you more likely to develop TTM.
• Stress and coping: Hair pulling may start during times of stress or boredom. This might turn into a habit that’s difficult to stop.

Because the cause isn’t fully understood, there’s no known way to prevent it.

Is trichotillomania genetic?

Yes, genetics can play a role in this condition. You may be more likely to develop it if a biological family member also has it. However, it can happen if you have no family history.

Researchers are studying several genes that may be involved. But the exact one isn’t known yet. Research is ongoing to understand how genetics may cause TTM.

Risk factors of trichotillomania

TTM can affect anyone. It’s more common if you’re:

• Between the ages of 10 and 13
• Feeling stressed, anxious or bored
• Female
• Struggling with low self-esteem

Complications of trichotillomania

Trichotillomania can affect both your body and your emotional well-being. Common complications include:

• Hair and skin damage: Repeated pulling can cause irritation, scarring or permanent hair loss. Sometimes, your skin underneath becomes sore or infected.
• Trichophagia (eating hair): About 1 to 2 out of every 10 people with trichotillomania eat their hair. This can cause hairballs (trichobezoars) that block your stomach or intestine and may require surgery to remove.
• Emotional strain: You may feel shame, guilt or embarrassment about hair pulling. This can lead to anxiety, depression or isolation from others.
• Daily impact: TTM can make school, work and social situations stressful. You might avoid activities like swimming, haircuts or dating because you don’t want others to notice the hair loss.

Some mental health conditions are also more common in people with TTM. These may happen alongside TTM or develop as a result of it. They include:

• Anxiety disorders
• Depression
• Obsessive-compulsive disorder
• Substance use disorders

How doctors diagnose trichotillomania

Your healthcare providers (often a dermatologist and then a mental health provider) will start by asking about your symptoms, mental health and medical history. They’ll also examine your scalp or other affected areas. They'll check to make sure the hair loss isn’t due to another condition, like a skin problem or a different mental health issue.

If your provider suspects TTM, they’ll compare your symptoms with the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It’s important to be open and honest, even if you feel embarrassed. Your provider’s goal is to help you feel better.

Most of the time, tests aren’t needed. But your provider may do a punch biopsy. This takes a small sample of skin to rule out other problems that can cause hair loss.

If your provider suspects you’ve swallowed hair, they may order imaging tests (like a CT scan) or blood tests to check for blockages or anemia. These tests help them understand what’s happening inside your body and guide treatment.

How is trichotillomania treated?

Your healthcare provider may recommend a combination of therapy and medications to help you manage symptoms.

• Therapy: The main treatment is habit reversal therapy (HRT). This type of therapy helps you notice when and why you pull your hair, and then teaches new ways to respond to those urges. Other helpful therapies include dialectical behavior therapy and acceptance and commitment therapy.
• Medications: You may use medications alongside therapy, not usually by themselves. There isn’t one specific medication that cures trichotillomania, but some can help reduce anxiety, depression or strong urges to pull hair. Your provider will help you find what works best for you.

If you have hair loss or scarring, your provider may recommend different options to treat skin problems or damage. Sometimes, a plastic surgeon can repair your skin with a procedure, like a skin graft. Other doctors may suggest ways to help your hair grow back, but regrowth isn’t always possible.

Trichotillomania medication

Your provider may recommend certain medicines to help manage TTM symptoms. Examples include:

• Antidepressants (like SSRIs) to help with mood and reduce urges
• Antipsychotics (like olanzapine) to control compulsive behaviors
• Over-the-counter supplements (like N-acetylcysteine) that may reduce the urge to pull hair

When should I see my healthcare provider?

See your primary care provider or mental health provider if you:

• Tried to stop pulling your hair but can’t resist
• Are stressed out because of hair pulling
• Have bald patches or visible areas of hair loss
• Have skin damage, open sores or signs of infection on your scalp or body
• Swallowed hair and now have stomach pain or digestive problems

A healthcare provider can confirm whether your symptoms are due to TTM or another condition. They can also offer support, discuss treatment options and connect you with resources to help you manage symptoms.

What can I expect if I have trichotillomania?

In children, hair pulling may be a short-term way to cope or self-soothe when they’re upset. It often goes away on its own. In teens and adults, hair pulling is more likely to last longer. It may need treatment and support from healthcare providers to get better.

TTM usually isn't dangerous to your health, but it can affect how you feel about yourself. Long-term issues may cause scarring or permanent hair loss. In rare cases, swallowing hair can cause stomach or bowel problems.

Therapy, medicine or both may help. Everyone’s recovery is different. Many people experience periods of improvement followed by relapse (times when you go back to old habits). This is normal. Your provider can guide you, help set goals and support you as you heal.

What’s the difference between trichotillomania and obsessive-compulsive disorder?

TTM is part of the obsessive-compulsive disorder (OCD) spectrum, but it’s not the same condition. Here’s how they differ:

• Obsessions: OCD involves unwanted, intrusive thoughts or urges (obsessions). TTM doesn’t include these kinds of thoughts.
• Feeling of reward: TTM causes relief or satisfaction after hair pulling. In OCD, performing a compulsion doesn’t bring positive feelings — it only reduces anxiety.