More commonly known as “hair-pulling disorder,” trichotillomania is a mental health condition that — you guessed it — causes folks to regularly pull out their hair.
What is trichotillomania?
Trichotillomania is recognized as an obsessive-compulsive and related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). If left untreated, it can last for years and lead to hair loss and thinning.
- Aliases: TTM, hair-pulling disorder
- Main symptom: regularly pulling out hair
- Risk factors: genetics, age, stress, or other conditions
- Treatment: therapy or medication
According to the National Organization for Rare Disorders, trichotillomania isn’t just limited to the hair on your scalp. You may feel the urge to pull hair from other areas, including:
- pubic hair
About 0.5 to 2 percent of people are affected with trichotillomania. If you’re living with trichotillomania, or think you might be, here’s how to identify symptoms and find the right treatments.
For some, the symptoms of trichotillomania are mild and rather manageable. For others, they may feel as though the symptoms are overwhelming and impossible to overcome.
Common signs and symptoms include:
- repeatedly pulling out your hair, most commonly from your scalp, eyelashes, eyebrows, beard, or pubic area
- breaking or ripping off pieces of your hair
- biting, chewing, or even eating (aka trichophagy) pulled out hair
- playing with pulled out hair, rubbing it against your face, or running it across your lips
- experiencing feelings of relief, satisfaction, or pleasure during or after pulling hair
- experiencing tension or anxiety before pulling or when you’re trying to keep yourself from pulling
- unsuccessfully attempting to stop or lessen the frequency of hair pulling
- hair loss, irritation, infection, or scarring in the area(s) where hair is pulled
While the exact cause of trichotillomania is unknown, both genetic and environmental factors are likely at play in its development.
The following factors may increase your risk of trichotillomania:
- Genetics. More research is needed, but a 2011 research review suggested genetics may contribute to trichotillomania. It’s particularly common for people with an immediate relative with the condition.
- Stress. We all know stress can wreak havoc on our bodies and minds, so it’s no surprise that extreme stress may trigger trichotillomania.
- Age. According to a case report, trichotillomania generally develops around early adolescence, most often between 10 to 13 years old. It’s a chronic condition, so while it may ebb and flow, it can worsen without treatment.
- Sex. Some women may experience an increased urge to pull their hair out during their period. One study suggested this urge might be a result of the hormonal changes, but more research is needed to determine this. One 2013 case report suggested that trichotillomania symptoms may also worsen during pregnancy.
- Other conditions. Trichotillomania is sometimes linked to conditions like OCD, anxiety, depression, and ADHD. But it’s important to note that not everyone with these conditions experience a hair-pulling disorder, and vice versa.
Trichotillomania in children or toddlers
Even though trichotillomania doesn’t usually start until those adolescent years, infants and small children can also go through a period of hair pulling. These cases are often mild and disappear with age.
Trichotillomania can manifest in a variety of ways, whether it be a response to stress or as an ingrained habit. Those with the condition commonly experience:
- Intense focus. Sometimes, hair pulling is a super intentional action, satisfying an urge to pull hair or as part of a ritual or routine. For some with TTM, the method of finding that “just right” hair to pull out is just as satisfying as the act itself.
- Involuntary response. While hair pulling can be intentional, it can also be completely automatic that you don’t even realize you’re doing it. Most people experience both focused and involuntary bouts of hair pulling, rather than one or the other.
- Anxiety and stress. Some people use hair pulling as a way to cope with not-so-pleasant feelings, including stress, anxiety, frustration, or simple boredom.
- Satisfying an urge. People with TTM often feel that they can’t get no satisfaction… until they pull out their hair. This offers a sense of sweet relief, which they may try to achieve again and again by regular hair-pulling.
- Developing other habits. Nail biting, skin picking, and lip chewing are also common habits that go with trichotillomania.
- Need for privacy. Those with TTM may try to hide their condition and its visible symptoms, often out of shame or embarrassment.
Trichotillomania can become more complicated than just pulling out hair. Common complications include:
- Emotional health conditions. Trichotillomania can take a toll on your emotional health, and those with it may experience embarrassment, shame, low self-esteem, depression, or anxiety.
- Interference with your daily activities. Those with TTM often try to hide their symptoms out of shame or embarrassment. Trichotillomania-related hair loss may cause them to shy away from social situations, avoid relationships, and even pass on job advancements or opportunities.
- Impacting hair and skin. Not only can constant hair-pulling permanently impact hair growth, but it can also damage the skin where you’re pulling. You can experience scarring or even infections in these areas (which can get even worse if you’re using a sharp tool, like tweezers!).
- Physical health conditions. Hairballs aren’t solely a cat thing. According to a case report more than 20 percent of people with trichotillomania eat their hair after pulling it out. This causes hairballs to form in their digestive tract. These small hairballs can lead to digestive issues, vomiting, weight loss, and possibly death.
Trichotillomania treatments aren’t one-size-fits-all and research is still limited on their effectiveness. Depending on your specific symptoms and their severity, it can take time and patience to find what works for you.
Behavioral therapy is the most common form of treatment for trichotillomania, particularly habit reversal therapy (HRT), according to a 2012 case report. So, how exactly does it work? HRT helps overcome TTM by:
- increasing your awareness of triggers and symptoms of TTM
- replacing hair pulling with a new, positive behavior
- finding motivation to prevent and stop hair pulling
- applying these new skills in different scenarios
Your doctor may also recommend undergoing HRT in combination with traditional cognitive therapy or acceptance and commitment therapy.
While there currently aren’t any medications approved by the FDA to treat trichotillomania, a 2013 research review suggested that the following might be effective in helping ease symptoms:
Because more research is needed, your healthcare provider may prescribe medication in partnership with therapy options.
Unless your hair follicle is completely dead due to damage, your hair should grow back.
If you’re struggling to regrow hair, talk with your doctor. They may suggest other options, dietary changes, or prescribe medication to help you achieve the regrowth results of your dreams.
These tips for luscious locks (or lashes, brows, etc.) may also be helpful.
For your scalp
Oil up! Try treating your scalp with a natural or essential oils, like:
Pro tip: Make sure to do a patch test first and dilute everything properly!
For your eyelashes
For your eyebrows
Try a supplement or topical serum for bushy brows.
Trichotillomania is a chronic condition. It can come and go over the course of months or even years. When left untreated, symptoms can worsen or become more frequent over time.
According to a case report, up to 50 percent of people living with trichotillomania see short-term symptom reduction when diagnosed early, while only about 14 percent see improvement without treatment.
If you find yourself regularly pulling out your hair or experiencing other symptoms of TTM, it’s time to talk with your doctor. They can provide you with an accurate diagnosis and work with you on a recovery plan.