What is a Trichotillomania?

Trichotillomania is a kind of impulse control disorder in which a person experiences an irresistible compulsion to pull out all of their body hair.

Most commonly, patients will begin to tear at their scalp, eyebrows, and eyelashes. People with this condition understand that they can harm themselves by acting on these urges, and yet they are unable to stop themselves. Many will deny that they have a problem and might try to hide hair loss by wearing scarves, hats, and false eyebrows and eyelashes.

It is not known what causes trichotillomania. However, some experts believe it could be related to abnormalities within the brain pathways linking areas that are involved with movement, emotional regulation, impulse control, and habit formation.

Various risk factors are also thought to be linked to the disorder, including genetics, negative emotions, age, a feeling of positive reinforcement, and other mental conditions like obsessive-compulsive disorder or anxiety.

What are the Symptoms of Trichotillomania?

Aside from the trademark repeated hair pulling there are many other symptoms.

Symptoms include:

  • Feeling tense while trying to resist the impulse to pull at the hair
  • Feelings of satisfaction or relief after pulling hair
  • Problems with one’s work and social life because of the hair pulling
  • Bare patches in the places where hair has been torn out
  • Chewing, biting, or eating the hair
  • Hair twirling
  • Inspecting the hair
  • Picking at skin
  • Nail biting
  • Lips chewing

Trichotillomania Causes

The cause of trichotillomania is unknown, but it is generally seen in patients with anxiety disorders or stress. It appears to run in families in some cases, but whether a link between family members is due to genes or whether children growing up with a parent or other older family member with the disorder see it as a means of relieving stress, is unclear.

While trichotillomania is often seen as a response to stress, it can also present itself while the patient is calm, such as while watching television, reading or grooming and can be an unconscious activity. Because there have been signs of disruption in brain chemistry, trichotillomania is often regarded and treated as a medical illness along with a mental one.

It’s often seen in conjunction with numerous other mental conditions, along with dermotillomania, a similar compulsion involving the picking at the skin, and is on the Obsessive Compulsive Disorder spectrum.

How is a Trichotillomania Treated?

In some cases, trichotillomania is relatively mild and easily managed. For others, the condition becomes severe and requires various therapies designed to help override those impulses that are telling them to tear out their hair.

Habit rehearsal training, a form of behavioral therapy, will teach the patient to replace the bad habit with another one that is not harmful to them. If needed, antidepressant and antipsychotic medications can be prescribed in conjunction with behavioral therapy.

Trichotillomania Prevention

Because trichotillomania is usually attached to other mental and emotional disorders or periods of stress, the best way to prevent trichotillomania would be to maintain good mental and emotional health. It’s also important to be aware of the symptoms and seek treatment before it becomes severe.

If you are approaching an event or period of time you know will be stressful, seek out support from family or friends and possibly seek help from a doctor or therapist. If you begin to notice symptoms of trichotillomania in your daily life without a specific event, speak to a therapist or doctor who can help you manage the underlying cause and possibly prevent the disorder from becoming a bigger problem.

For those with increasingly more severe symptoms, other disorders can become worse. Bald patches across the scalp can increase feelings of isolation or anxiety that others will notice and comment on, which can increase the stress that results in hair-pulling.

Patients are sometimes prescribed anti-anxiety medication or antidepressants as treatment, along with behavioral therapies, including stress management courses, in order to prevent and manage trichotillomania.

Last Reviewed:
October 11, 2016
Last Updated:
September 10, 2017