Trichotillomania (Hair Pulling Disorder)

Trichotillomania, also known as hair pulling disorder, is when someone can’t resist the urge to pull out their hair. They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes.

Trichotillomania is more common in teenagers and young adults, and tends to affect girls more often than boys. Trichotillomania (TTM) is a mental disorder in which people feel an overwhelming need to pull out their own hair. Research suggests that 0.5 to 2 percent Trusted Source of people have TTM.

People with trichotillomania feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief.

A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it.

Most people with trichotillomania pull out hair from their scalp, but some pull out hair from other areas, such as their: Eyebrows, eyelashes, genital area and beard or moustache

Bald patches left on the head tend to have an unusual shape and may affect one side more than the other.

Trichotillomania may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

Symptoms of trichotillomania include

• pulling out hair repeatedly
• breaking off pieces of hair
• eating hair (trichophagy)
• feeling relieved after pulling hair out

Causes of Trichotillomania

It’s not entirely clear what causes trichotillomania. It could be:

• A way of dealing with stress or anxiety
• A chemical imbalance in the brain, similar to obsessive compulsive disorder (OCD)

changes in hormone levels during puberty

• A type of self-harm to seek relief from emotional distress
• For some people, hair pulling can be a type of addiction. The more they pull their hair out, the more they want to keep doing it.
• Depression
• Autism
• Attention deficit hyperactivity disorder (ADHD)

What are the complications of trichotillomania?

Infection, skin damage and permanent hair loss are possible complications of trichotillomania. The hair loss and skin damage can lead to problems with self-esteem and body image, and can have a negative impact on work and relationships. In extreme cases, some people might avoid social situations in order to hide the resulting hair loss.

People who engage in trichophagia (eating hair) are at risk for forming trichobezoars, or balls of hair, in the stomach or small intestines. Trichobezoars can lead to pain, nausea and vomiting, bleeding, blockages, and other serious gastrointestinal problems.

Diagnosis

To diagnose trichotillomania, Dr. Civas will talk to you about your medical history, as well as symptoms you may be experiencing. He 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 research, 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)

Therapy

Types of therapy that may be helpful for trichotillomania include:

• Habit reversal training.This behavior therapy is the primary treatment for trichotillomania. You learn how to recognize situations where you’re likely to pull your hair and how to substitute other behaviors instead. For example, you might clench your fists to help stop the urge or redirect your hand from your hair to your ear. Other therapies may be used along with habit reversal training.
• Cognitive therapy.This therapy can help you identify and examine distorted beliefs you may have in relation to hair pulling.
• Acceptance and commitment therapy.This therapy can help you learn to accept your hair-pulling urges without acting on them.

Appointment Date

The 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.

• 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?