Trichotillomania: Causes, Symptoms, and Treatments

According to Merriam-Webster, the word trichotillomania comes from the Greek trich-, which is a term for “hair,” and tillein, which means “to pull or pluck.”

Sometimes referred to as “trich” for short, trichotillomania is a mental health condition in which a person compulsively pulls out their own scalp and/or body hair. 

Occurring in less than two percent of adults, individuals with this mental health disorder need to deal with the near-constant urge to pull their own hair out, regardless of their desire to stop. The intensity of the desire to hair-pull is known to fluctuate over time. 

Trichotillomania differs significantly from other types of female hair loss, but it can have a major impact on your hair when severe. In the long term, this form of compulsive hair pulling can lead to significant loss of hair, broken hairs and, in some cases, permanent hair loss.

Like other mental health conditions, trichotillomania is usually treatable with medication, therapy or a combination of approaches. Most noticeable hair loss from trichotillomania is also treatable with changes to your habits and the use of hair growth medication.

Below, we’ve explained what trichotillomania is, as well as the symptoms you might notice if you have this disorder.

We’ve also discussed how you can treat this hair-pulling disorder, gain control over hair-pulling behavior and let your hair return to a healthy state.

Trichotillomania is a mental health disorder that’s generally considered to be a part of obsessive compulsive disorder, or OCD. 

Obsessive-compulsive disorders involve obsessions, or repeated thoughts, and compulsions, or repetitive behaviors. Common symptoms of OCD include fears and worries, as well as a need to engage in compulsive behaviors in response to these feelings.

Trichotillomania was first noted in ancient Greece, and has been recognized throughout history in different societies. However, it wasn’t officially recognized as a mental disorder until the 1987 edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). 

In the DSM-5, trichotillomania was included alongside OCD and related disorders, such as body dysmorphic disorder, hoarding disorder and excoriation disorder. 

Trichotillomania can occur at any age and affects men and women. However, it’s most common in women. The typical age of onset between 10 and 13 years. Approximately four times as many adult women are affected by trichotillomania as adult men. 

The most significant symptom of trichotillomania is hair pulling, which can affect the scalp and/or other parts of the body. According to research, around 70 percent of people with trichotillomania pull on their scalp hair, with the eyebrows and pubic region the next most common areas. 

Many people with trichotillomania feel compelled to pull their hair out when they’re exposed to a certain trigger. Common triggers for trichotillomania can include:

• Reaching a certain hair length or level of hair thickness

• Seeing hair on a part of your body that “shouldn't” have it

• Certain physical sensations, including those that affect your scalp

• Specific feelings, such as anxiety, boredom, agitation or anger

• Recurrent thoughts about your hair or general appearance

Some people with trichotillomania pull on their hair without even noticing — an issue that’s often referred to as “automatic” pulling. Others pull their hair consciously in response to a trigger or feeling that something is wrong with their hair or scalp. 

Because trichotillomania involves hair pulling, it can cause noticeable, chronic hair loss that can affect the appearance of your scalp hair, facial features and pubic hairs. You may notice bald or thinned patches on your scalp, or areas with low hair density due to pulled-out hairs.

It can also affect your skin, particularly if you use tweezers, scissors or other instruments to cut or tug on your hair. These may include skin irritation, cuts and other injuries that can form when these instruments are misused or used excessively.

Approximately 20 percent of people with trichotillomania eat their hair after pulling it out. This can potentially lead to gastrointestinal issues, including the development of trichobezoars (hair balls) that can block the digestive system and affect its ability to function normally.

In addition to causing physical symptoms, trichotillomania can also affect your mental wellbeing and quality of life.

Mental health issues associated with trichotillomania include anxiety disorders, such as social anxiety disorder, low self-esteem and ongoing psychosocial dysfunction.

These issues may contribute to a vicious cycle in which trichotillomania symptoms grow more severe. People with trichotillomania may change their behavior in response to their symptoms, including by avoiding career advancement or opportunities to socialize.

In short, trichotillomania affects more than just your hair. Because of its impact on your mental wellbeing, it can affect everything from your appearance and behavior to the way you perceive yourself and interact with others.

Trichotillomania Diagnosis

If you think you might have trichotillomania, one of the most important steps that you can take is to talk to your healthcare provider.

Trichotillomania is a recognized mental health disorder, and talking to a professional can make it easier for you to get help. Your healthcare provider may refer you to a mental health provider for a meeting and diagnostic interview about your symptoms. 

Many people with hair-pulling disorder are reluctant to seek professional help due to feelings of embarrassment or shame about the condition, as well as the belief that medical providers may not know how to effectively treat them.

It’s important to set these feelings aside if you’re concerned that you may have this disorder, as making progress is very possible with the right approach.

Currently, there are five criteria that are required for a diagnosis of trichotillomania:

• Hair pulling from a specific body region, such as the scalp, face or abdomen
  

• Some attempts to stop or reduce the severity of compulsive hair-pulling behavior
  

• Distress, impairment or a reduction in your overall quality of life due to hair pulling
  

• An absence of medical conditions that could explain hair loss, such as alopecia areata or female pattern hair loss
  

• No existing diagnosis of a psychiatric condition that could cause the hair pulling, such as an anxiety disorder

To diagnose trichotillomania, your healthcare provider will typically ask you questions about your symptoms and behavior. They may also examine your scalp, face and other regions affected by hair pulling to look for signs of skin irritation or damage to your hair follicles. 

Like with many other mental health disorders, experts aren’t yet aware of precisely what causes trichotillomania to develop. 

Trichotillomania often occurs alongside other mental conditions, suggesting that overall mental health factors may play a role. For example, many people with trichotillomania also suffer from major depressive disorder, substance use disorder and/or anxiety.

Some research suggests that genetic factors likely play a role in trichotillomania. Family studies, for example, show that people with first-degree relatives affected by trichotillomania also have a higher risk of reporting the condition. 

Studies using neuroimaging technology have also found that activity in some brain regions may play a role in compulsive behaviors such as chronic hair pulling.

From a psychological standpoint, some experts believe that trichotillomania may occur as a type of relief behavior. People with this condition might use hair pulling to escape from situations that cause anxiety, or to get temporary relief from feelings of sadness, anger or frustration.

Overall, it appears that a variety of factors, from genetics to habits and overall mental wellbeing, appear to play a role in trichotillomania.

Trichotillomania is a treatable condition. Treatment for trichotillomania usually involves a mix of talk therapy, such as cognitive behavior therapy (CBT), and the use of medications to help you stay in control of compulsive behaviors such as hair pulling.

Therapy for Trichotillomania

As a mental health disorder, trichotillomania often gets better with cognitive behavioral therapy, particularly habit reversal therapy.

This type of therapy involves identifying cognitive distortions — internal mental filters or biases that can contribute to negative thoughts and behaviors — then taking steps to change them to prevent harmful behaviors from occurring.

Habit reversal training focuses on self-monitoring of hair-pulling behavior, as well as awareness training and stimulus control.

As part of this type of behavioral therapy, your mental health provider may ask you to take notes when you feel the urge to pull your hair. Over time, you may identify situations or other triggers that contribute to your symptoms, then develop strategies to effectively deal with these.

We offer online therapy as part of our range of mental health services, allowing you to easily find and talk to a licensed therapy provider without having to leave your home. 

Trichotillomania Medication

Currently, there’s no FDA-approved medication specifically for trichotillomania. However, some studies show that selective serotonin reuptake inhibitors (SSRIs), a group of medications used to treat depression and anxiety, may offer benefits for people affected by this disorder. 

There’s also evidence that clomipramine, a tricyclic antidepressant (TCA), could make it easier to manage some trichotillomania symptoms.

Your healthcare provider may recommend using medication for trichotillomania on its own or in combination with therapy. Make sure to closely follow their instructions and only use medication as prescribed. 

Trichotillomania can have a serious impact not just on your hair, but also on your mental health, social life and overall wellbeing as an individual.

If you pull your hair frequently and think you might have trichotillomania, it’s important to talk to a mental health professional. They can ask you about your symptoms and, if appropriate, suggest steps that you can take to overcome the urge to pull your hair and damage your hair follicles. 

This could mean taking part in cognitive therapy, taking medication, or using several techniques to gain awareness of hair pulling and stop yourself from engaging in this behavior.

You can access help for trichotillomania by contacting your primary care provider, meeting with a mental health provider in your area, or from home using our online mental health services.

You can also learn more about your options for regrowing hair and caring for your hair follicles with our detailed guide to the best female hair loss treatments.