Healthy Living

What Is Trichotillomania: Causes and Symptoms

What Is Trichotillomania?


Trichotillomania is also known as the hair-pulling disorder. It is categorized as a mental disorder, wherein there is an involvement of an irresistible as well as a recurrent urge to pull out the hair from the scalp, eyebrows, and other parts of the body with hair.

The urge to pull one's hair is there even if one tries to stop it. Due to hair-pulling from the scalp, it often tends to leave a patchy bald spot, which in turn leads to a significant amount of distress. Having the disorder can also interfere with an individual's work as well as social interactions.

Individuals who suffer from trichotillomania can go to any lengths to disguise the loss of their hair. In few of the individuals, the case of trichotillomania may be mild and can be easily managed. However, in the case of others, it tends to further develop into a compulsive urge to pull one's hair. It becomes an overwhelming urge for the individual to carry out that activity. There have been certain treatment options, which have helped the individuals with this mental disorder in terms of reducing their hair-pulling urge or in certain cases, entirely cured the disorder.


The exact cause of this mental disorder is still unclear, but similar to other forms of complex mental disorders, trichotillomania is probably a result of the combination of environmental factors as well as genetic issues.


Below are some of the symptoms of trichotillomania, which an individual may experience:

  • Before the pulling of hair, the individual may have an increasing sense of tension building up in their mind. It can also occur when the individual is trying to resist the act of hair-pulling.
  • The individual may try to bite, chew, or eat the strands of hair that have been pulled out.
  • The repeated instances of hair-pulling usually happen in the scalp, eyelashes, or eyebrows. Hair-pulling can also be done from other parts of the body wherever hair is present. The sites would also tend to vary from time-to-time.
  • After the pulling of hair, the individual feels a sense of relief or pleasure.
  • There is a tendency of the individual to start playing with the hair, which has been pulled out. They can also try to rub it in their face or their lips.
  • There is a noticeable sign of hair loss due to hair-pulling. Few of the noticeable signs would include thinned hair, shortened hair, bald patches on the scalp, or hair loss in other parts of the body. This constant sign of hair-pulling can also lead to sparse, minimum, or missing sections of eyebrows or eyelashes.
  • The individual tends to face a significant amount of distress or trouble at work, home, school, or any other social places, which are related to the individual pulling out hair.
  • There are preferences of the individual to specific types of hair or rituals, which would accompany the pattern related to hair-pulling or can accompany hair-pulling instances.
  • The individual would also try to constantly stop pulling their hair or try to carry it out less often without any success of the same.

There have been cases reported that many a time, individuals who suffer from trichotillomania also tend to pick their skin, tend to chew their lips, or bite their nails. Few of the other symptoms would also relate to pulling hair from dolls, and other materials, which can include clothes and blankets. Moreover, hair-pulling can also be done to pets. There are certain individuals who tend to pull their hair when they are alone with the intention of trying to hide their disorder or behavior from others to avoid any kind of social embarrassment.

For those individuals who suffer from trichotillomania, hair-pulling instances can be:

  • Automatic Sign: Some of the individuals tend to pull their hair without even realizing that they are doing it. They normally tend to pull their hair out when they are bored, while they are watching TV, while reading a book, or while studying.
  • Focused: Few of the individuals tend to intentionally pull their hair so as to give themselves some kind of relief from the tension or distress they are facing. One of the examples would be carrying out hair-pulling to get relief from the overwhelming urge of pulling one's hair. Some individuals tend to develop an elaborate ritual when it comes to the pulling of hair. It may include finding the right type of hair or biting the hair that has been pulled out. It can be possible that the same individual tends to have both the automatic as well as the focused type of hair pulling. It all depends on the mood and specific situations of the individual. There are certain kinds of positions or rituals, which can trigger hair-pulling, and they can include resting the head on one's hands or when an individual is brushing his or her hair.

It has been found out that this mental disorder is related to an individual's emotions:

  • Positive Emotional Feelings: Those individuals who suffer from trichotillomania often find out that the pulling of hair provides them a sense of satisfaction. Moreover, for them, hair-pulling is also a measure of mental relief from any kind of distress. As a result, those individuals often tend to continue to pull their hair so as to maintain this positive kind of feeling within themselves.
  • Negative Emotional Feelings: It has been seen that for many individuals who are suffering from this mental disorder, the action of hair-pulling is one of their ways to effectively deal with negativity or when dealing with any kind of uncomfortable feelings. Those uncomfortable or negative feelings may include tension, loneliness, boredom, anxiety or panic attack, frustration, fatigue, and stress, which can be emotional, physical, or mental. 

Trichotillomania is regarded as a chronic or a long-term mental disorder. If there are no proper treatments carried out, then the symptoms caused by this disorder may become severe over time. For certain individuals, if no proper treatment is carried out, then the symptoms of this disorder can come and go for a couple of weeks, months, or even take years as well. In very rare cases, there is a possibility that an individual's hair-pulling habit would end within just a few years from the time it had started.

Risk Factors 

  • Age of the Individual: Trichotillomania is known to develop in an individual just before the onset or during their early teenage years. It usually occurs between the ages 10 to 13 years old. The disorder then tends to become a lifelong chronic issue, which requires proper treatment. There have been certain cases wherein infants have also shown to have the habit of hair-pulling. However, in such cases, hair-pulling is mostly mild and would go away on its own without the need for any medical treatment.
  • Family History: It is widely known that genes have their own significant roles to play when it comes to the most complex disorders. Similarly, genetics is said to play a role in the development of trichotillomania. Hence, it can be said that the occurrence of this disorder can mostly happen to those individuals who have some close relatives who are already suffering from this disorder.
  • Stress: In certain individuals, there have been instances of several stressful situations or events, which can trigger this mental disorder. Stress can be related to a person's physical, emotional, or mental health.
  • Other Forms of Disorders: Individuals who suffer from trichotillomania may also have instances of other forms of disorders, which can include anxiety attacks, depression, and OCD, which is also known as obsessive-compulsive disorder.

When should one visit the doctor?

So when would be the right time to visit the doctor? If an individual is unable to stop the habit of pulling his or her hair and if the person feels embarrassed or ashamed due to his behavior and appearance, then it is best to speak with a doctor.

Trichotillomania is not just a bad habit. It is important to understand that it is a form of mental disorder, which is unlikely to get better without the help of certain treatment programs.


There are certain evaluations, which would need to be carried out to determine if the individual is suffering from trichotillomania. Evaluations would include:

  • Examining how much hair the individual has lost.
  • Asking questions as well as having a discussion about hair loss.
  • Ruling out other medical conditions through carrying out certain tests. 
  • Identifying the type of physical or mental health problem, which may be associated with the issue of hair-pulling.


There are various therapies, which are known to be helpful for those individuals who suffer from trichotillomania. Therapies would include:

  • Cognitive Therapy: In this type of therapy, any kind of distorted belief can be identified and examined. Such belief may be associated when it comes to the pulling of one's hair. 
  • Habit Reversal Training: This therapy is regarded as one of the primary treatments when it comes to treating someone with trichotillomania. A habit reversal training would help an individual with trichotillomania to recognize the instances, wherein they tend to pull their hair. Individuals are usually taught to substitute other behaviors in its place. One of the examples would be to tightly clench their fists to help them resist the urge of hair pulling. They can also redirect their hand to their ears instead of their hair. Other therapies can also be used along with habit reversal training to help the individual overcome the constant habit of hair pulling.
  • Therapy of Acceptance and Commitment: In this particular therapy, individuals with trichotillomania learn to accept their hair-pulling urges without acting too much on it.

Other forms of mental disorders are also known to be associated with trichotillomania. Those mental disorders include anxiety, depression, or substance abuse, which can also be important contributing aspects of the treatment plan.


Currently, there are no FDA-approved medications or drugs that are specifically helpful in treating someone with trichotillomania. However, there are certain medications, which can be useful in controlling few of the symptoms caused by this mental disorder.

The doctor can recommend the use of an antidepressant such as clomipramine. Other medications or drugs that can help would include N-acetylcysteine, which is basically an amino acid that influences the neurotransmitters that are directly related to the mood of an individual. Another medication is olanzapine, which is classified as an atypical antipsychotic.

Do not take any type of medications without consulting a doctor first. It is recommended to speak with a doctor before taking any type of drug for proper diagnosis and treatment. 


Most of the time, individuals with trichotillomania tend to feel lonely in their hair-pulling experience. It would be helpful for them to join certain support groups, so that they can meet other individuals with the same issue. They can discuss their experiences and also express their feelings to the group.