Trichotillomania (TTM), (trik-o-til-o-MAY-nee-uh), also called hair-pulling disorder, is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. Research suggests that 0.5 to 2 percentTrusted Source of people have TTM.
Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.
For some people, trichotillomania may be mild and generally manageable. For others, the compulsive urge to pull hair is overwhelming. Some treatment options have helped many people reduce their hair pulling or stop entirely.
Trichotillomania usually develops during the adolescent years, but it’s been known to appear in young children, too. Once it starts, it can continue for several years, continuing through adulthood. It affects males and females equally in childhood but can affect females more often during adulthood.
Some women report having more urges to pull out their hair during the start of their menstrual cycles. A 2018 article in Psychology ResearchTrusted Source notes that the hormonal changes happening in a woman’s body during the start of their cycle may have an impact on symptoms of trichotillomania, but researchers aren’t sure why.
A 2013 case study noted that symptoms of trichotillomania may also get worse during pregnancy due to hormonal changes.
Signs and symptoms of trichotillomania often include:
- Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time
- An increasing sense of tension before pulling, or when you try to resist pulling
- A sense of pleasure or relief after the hair is pulled
- Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
- Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
- Biting, chewing or eating pulled-out hair
- Playing with pulled-out hair or rubbing it across your lips or face
- Repeatedly trying to stop pulling out your hair or trying to do it less often without success
- Significant distress or problems at work, school or in social situations related to pulling out your hair
Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.
For people with trichotillomania, hair pulling can be:
- Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
- Automatic. Some people pull their hair without even realizing they’re doing it, such as when they’re bored, reading or watching TV.
The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.
Trichotillomania can be related to emotions:
- Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.
- Positive feelings. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.
Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.
When to see a doctor
If you can’t stop pulling out your hair or you feel embarrassed or ashamed by your appearance as a result of your hair pulling, talk to your doctor. Trichotillomania is not just a bad habit, it’s a mental health disorder, and it’s unlikely to get better without treatment.
Trichotillomania Causes and Risk Factors
Researchers aren’t sure what causes trichotillomania. There may be a genetic reason why people develop it. Environmental factors may also play a role.
According to a 2016 studyTrusted Source, the typical age for the symptoms to appear is between 10 and 13 years old. Symptoms usually start with pulling out the hairs on the scalp, which makes the person feel less anxious or stressed.
Many people don’t even notice themselves pulling their hair. The realization that they are pulling out hair can lead to more feelings of anxiety and embarrassment. This creates a cycle of anxiety, hair pulling, temporary relief then anxiety, embarrassment, and hair pulling again.
Trichotillomania is a mental health condition that is sometimes related to other conditions such as:
- obsessive-compulsive disorder (OCD)
- attention deficit hyperactivity disorder (ADHD)
Not everyone who has these conditions will experience trichotillomania. Symptoms may start for many reasons, including:
- enjoying feeling the thickness of hair on their fingers
- enjoying feeling the sensation of pulling hair on the scalp
- emotions like anxiety, boredom, anger, shame, or stres
Some things may boost your risk of trichotillomania, including:
- Age. Trichotillomania usually starts in the early teens, between ages 10-13. It can last throughout life, though symptoms may come and go.
- Genes. In some families, the tendency to trichotillomania may be passed on. It’s more likely if another family member has it.
- Other mental health disorders. If you live with trichotillomania, you may have other mental health problems, such as anxiety, depression, or obsessive-compulsive disorder (OCD).
- Stress. Extreme stress may trigger trichotillomania in some people. Stress can be triggered by situations including family conflict, abuse, or the death of a friend or family member.
Trichotillomania is diagnosed based on its symptoms. There’s no specific test for it.
To diagnose trichotillomania, your doctor will talk to you about your medical history, as well as symptoms you may be experiencing. They will likely use the criteria in the new edition of the Diagnostic and Statistical Manual of Mental Disorders to see if your symptoms match up.
According to the DSM-5, someone diagnosed with trichotillomania must meet the following:
- recurrent pulling out of one’s hair, resulting in hair loss
- repeated attempts to decrease or stop hair pulling
- hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- hair pulling or hair loss that is not attributable to another medical condition (e.g., a dermatological condition)
- hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)
Your doctor will also rule out any other causes of hair loss and may send you to a dermatologist (skin doctor).
Although it may not seem particularly serious, trichotillomania can have a major negative impact on your life. Complications may include:
- Emotional distress. Many people with trichotillomania report feeling shame, humiliation and embarrassment. They may experience low self-esteem, depression, anxiety, and alcohol or street drug use because of their condition.
- Problems with social and work functioning. Embarrassment because of hair loss may lead you to avoid social activities and job opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
- Skin and hair damage. Constant hair pulling can cause scarring and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled and can permanently affect hair growth.
- Hairballs. Eating your hair may lead to a large, matted hairball (trichobezoar) in your digestive tract. Over a period of years, the hairball can cause weight loss, vomiting, intestinal obstruction and even death.
Trichotillomania Treatment and Home Remedies
Many types of therapy can support people with trichotillomania and even help them stop hair pulling completely.
- Acceptance and commitment therapy. You’ll be able to practice accepting the hair-pulling urges without actually hair pulling.
- Habit reversal. This is often the main treatment for trichotillomania. It’ll help you practice other, less harmful habits instead of hair pulling, like clenching your fists when you have the urge to pull your hair.
- Cognitive therapy. This helps people explore and change the beliefs that lead to hair pulling
There are no FDA-approved medicines for trichotillomania, but these drugs may control symptoms in some people:
- Atypical antipsychotics
- N-acetyl-cysteine, an amino acid supplement
Coping and support
Many people with trichotillomania report feeling alone in their experience of hair pulling. It may help to join a support group for people with trichotillomania so that you can meet others with similar experiences who can relate to your feelings.
Ask your doctor or mental health professional for a recommendation or consider searching online for a trichotillomania support group.
Preparing for your appointment
Seeking help is the first step in treating trichotillomania. At first you may see your primary care doctor or a dermatologist. He or she may refer you to a mental health professional.
What you can do
Before your appointment make a list of:
- All the symptoms you’re experiencing, even if they seem unrelated to hair pulling. Trichotillomania can cause both physical and psychological symptoms. Note what triggers your hair pulling, how you’ve tried to deal with the problem, and factors that make it better or worse.
- Key personal information, including any major stresses or recent life changes and whether hair pulling runs in your family.
- All medications, vitamins, herbs or other supplements that you’re taking, including the dosages and how long you’ve been taking them.
- Questions to ask your doctor to make the most of your appointment time.
Questions to ask your doctor may include:
- What might have caused me to develop this disorder?
- How do you diagnose this condition?
- Is this something that will go away on its own? Is there anything I can do on my own to improve my symptoms?
- What treatments do you recommend?
- If I decide to take medications, how long will it take for my symptoms to improve?
- What are the side effects of the medications you’re recommending?
- How much improvement can I realistically expect if I follow your treatment plan?
Don’t hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- When did your hair pulling first start?
- Have you tried to stop pulling your hair? What was the result?
- Are there times or situations that are likely to trigger your hair pulling?
- What feelings do you have before and after you pull your hair?
- From where on your body do you pull hair?
- Do you bite, chew or swallow the hair?
- How has your hair pulling affected your work, school or social life?
- Have you had treatment (medication or therapy) for hair pulling or other emotional issues?
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- Trichotillomania. National Organization for Rare Disorders. http://rarediseases.org/rare-diseases/trichotillomania/. Accessed Sept. 30, 2016.
- Trichotillomania (hair-pulling disorder). Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/obsessive-compulsive-and-related-disorders/trichotillomania. Accessed Sept. 30, 2016.
- Iorizzo M, et al. Current and future treatments of alopecia areata and trichotillomania in children. Expert Opinion on Pharmacotherapy. 2016;17:1767.
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- Woods DW, et al. Diagnosis, evaluation, and management of trichotillomania. Psychiatric Clinics of North America. 2014;37:301.
- Rothbart R, et al. Pharmacotherapy for trichotillomania. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007662.pub2/full. Accessed Oct. 3, 2016.
- Whiteside SP (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 1, 2016.