Trichotillomania – Compulsive Hair Pulling Disorder

At any given time, approximately eight million people in the United States have a condition called trichotillomania. And this may be a low estimate. Most of the time, the people who experience this condition try to hide it because of embarrassment and the disfiguration that can occur with the condition.

What is Trichotillomania?

Trichotillomania is considered an impulse control disorder similar to other disorders like pathological gambling or other obsessive-compulsive disorders such as compulsive counting. A person who has trichotillomania pulls hair on various parts of their bodies. Most of the time, the hair of the eyebrows, eye lashes, or on top of the head are the sites of choice. But the hair growing on any part of the body may be pulled.

The sites for hair pulling also may change from time to time.

One thing that nearly all people who suffer from trichotillomania describe is a feeling of very significant tension just before they pull their hair. Then, after pulling out some hair, they report a feeling of relief. Sometimes, there is a ritual of sorts involved in the hair pulling, also.

The amount of hair that is pulled may be very significant. If the hair of the scalp is pulled, patches of baldness may result. This can cause impairment in social and work situations due to the physical and emotional results of trichotillomania.

Another aspect of this condition is that people aren’t able to stop the hair pulling on their own.

What Causes Trichotillomania?

The exact cause of this hair-pulling compulsion isn’t known. Like with so many psychological and physical conditions, the causes may be many. However, there are some typical causes that are known.

Like with many of the compulsion-based conditions, trichotillomania may be caused by anxiety from some source. Stress may also be a cause of this condition.

Clinical experience has shown a possible genetic component as a cause of trichotillomania. Many people who have this condition also have family members who either have or had the same compulsion. This genetic component may be triggered by a stressor of some kind, leading to the behaviors associated with this condition.

The same kind of clinical experience also shows this condition to be related to other habits children experience such as sucking a thumb. In this regard, trichotillomania also may be a habit resulting from some benign circumstance such as an itchy eyelash that takes on a life of its own, so to speak.

Many researchers believe this compulsion results from an imbalance or dysfunction of brain neurotransmitters. There is a possible link between a deficiency of serotonin and this condition. Other researchers have suggested an abnormality of some brain structures.

Who is Affected by this Condition?

Men and women both can contract this condition. Women are more likely to be affected. However, this may be because men more often will hide their symptoms of trichotillomania and will seek treatment for these symptoms less often than women.

This compulsion typically first shows itself in adolescence, but people of all ages can suffer from it. Children as young as four years of age have shown the symptoms, and adults as old as 60 years of age have begun the behaviors. Children are up to seven times more likely to have this condition than adults.

Trichotillomania is considered a chronic condition. The symptoms may come and go in a cyclical fashion or may continue unabated for months or even years. Professionals agree that the condition usually doesn’t go away by itself. Rather, the symptoms may disappear, reappear, grow less, then grow worse, but never go away.

Other Co-Occurring Conditions

Trichotillomania is a psychological condition related to other obsessive-compulsive conditions. All of these conditions have anxiety as a significant component. Thus, other anxiety-related symptoms may be seen with trichotillomania. Depression is also a commonly-seen co-occurring condition. Skin-picking, nail biting, and compulsive scratching may also co-occur with this condition.

Since this condition strikes typically during adolescence, the co-occurring conditions may be very significant. Lower self-esteem, difficulty with body image, impaired relationships with peers, and ridicule from peers because of the visible results of hair pulling all accumulate and cause harm. Many people tend to avoid close interpersonal relationships because of the shame of this “secret” condition.


As mentioned above, trichotillomania is considered a chronic condition that can’t be stopped by the person suffering from it without help. This is a compulsive condition that is related to anxiety. Usually, when people try to use their willpower to stop the compulsion, more anxiety is generated, leading to a stronger compulsion to pull hair.

A combination of a form of cognitive behavior therapy and medication is typically used to treat this condition. What appears to be the most effective form of cognitive behavior therapy is called habit reversal training. This approach views the condition as a learned response to certain triggers. The individual may not even be aware of these triggers. Thus, the first step is to help the person become aware of what brings on the hair-pulling behavior. Then, other behaviors incompatible with hair pulling are practiced to substitute them for the hair-pulling.

Another cognitive behavioral approach is called mindfulness based cognitive behavioral therapy. In this approach, the person is taught to accept uncomfortable situations rather than giving in to the anxiety that comes with them. Learning to accept those uncomfortable situations instead of reacting with hair pulling is the key to this approach.

While there are no medications approved specifically for treating trichotillomania, some medications that help the person deal with anxiety can be helpful.

All treatment efforts undertaken should be done only under the supervision of a professional.

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