What Is Trichotillomania? Symptoms, Causes And How To Overcome?

Trichotillomania is not a mental disorder, it is an impulse control disorder which is a type of psychological condition. This means that people with the condition feel an overwhelming urge to pull their hair despite trying to stop. They can pull out the hair from their arms, scalp, face, and pubic areas, resulting in noticeable bare spots. They also may have other compulsive habits, such as nail biting or skin picking. Some also have problems like depression, anxiety, or obsessive-compulsive disorder.

As most of the affected people refrain from revealing their condition, there are no correct estimates about the prevalence of trichotillomania in the society. The following are important statistics that may be helpful in better understanding this illness.

  • Less that 200,000 people in the US are affected by this disorder.
  • Adult women are diagnosed twice as often with trichotillomania as are adult men.
  • Automatic pulling occurs in approximately three-quarters of adult patients with trichotillomania.
  • Trichotillomania is diagnosed in all age groups. Onset is more frequent during preadolescence and young adulthood, with mean age of onset between 9 and 13 years of age, and a notable peak at 12-13.
  • It appears to be a female predominance among preadolescents to young adults, between 70-93% of patients being female.


What Is Trichotillomania? Symptoms, Causes And How To Overcome?

Environmental Factors

People with the disorder use this compulsive hair pulling behavior as a coping mechanism for stress. People who do this don't have conscious intentions of hurting themselves. Conversely, they use it to cope with complex emotions like anxiety and sometimes fear or panic.

Genetic Factors

It may be genetic that meaning they can sometimes run in families.

Abnormal Brain Chemistry

Experts think that compulsive behaviors like hair pulling may be caused by an imbalance in the brain's chemistry, such as serotonin and dopamine. A type of brain chemical, called neurotransmitters, is a normal part of the brain's communication center. When something interferes with how neurotransmitters work, it can cause problems like compulsive or repetitive behaviors.


  • Recurrent pulling out of one's hair resulting in noticeable hair loss.
  • Patchy bald areas on the scalp or other areas of the body.
  • Sparse or missing eyelashes or eyebrows.
  • Infected hair follicles.
  • Chewing or eating pulled-out hair.
  • An increasing sense of tension immediately before pulling out the hair or when resisting the behavior.
  • Pleasure, gratification, or relief when pulling out the hair.
  • Other associated behaviors may include nail biting, thumb sucking, head banging, or compulsive scratching.
    Frequently, hair pullers also find they compulsively pick at their skin, which may also cause physical and emotional scarring.
  • The disturbance is not accounted for by another mental disorder and is not due to a general medical condition.
  • The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning.

Additional Symptoms

  • Nausea
  • Vomiting
  • Stomach or Lower Abdominal Pain
  • Stomach Bleeding


Cognitive Behaviour Therapy (CBT)

Including Habit-reversal Therapy (HRT), and Acceptance & Commitment Therapy
It is common for treating trichotillomania and have been effective at relieving trichotillomania symptoms. In studies Behaviour Therapy fared better than common medications. Studies suggest that supportive therapies and psychoanalysis without the behaviour aspect are not effective at treating trich.

CBT takes a practical, problem-solving approach to change people's attitude and behaviour. It can help you address your thoughts about yourself, your relationships with others and how you relate to the world around you. CBT may also involve behaviour aspects to help you to change the way you behave.

HRT is a CBT technique that is widely recognised as the most effective treatment for trichotillomania. In a review of research into medications and behaviour therapies for trichotillomania, HRT was more successful than commonly used medications.

Examples Of Therapy Goals To Decrease Hair Pulling

  • Design a treatment plan to address your individual needs and concerns.
  • Identify trigger situations for pulling or picking.
  • Develop a variety of strategies and coping tools to manage hair pulling and resist the urges.
  • Develop habit replacement behaviors and stimulus control strategies.
  • Learn to respond differently to thoughts about your hair or skin.
  • Develop coping tools to manage stressful situations.
  • Help loved ones understand and develop ways to respond to pulling behaviors.
  • Family education.
  • Relapse prevention strategies.