A rarely discuss mental disorder that is associated with hair and hair loss.
Trichotillomania (trik-o-til-o-MAY-nee-uh), also called hair-pulling disorder, is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.
The hair pulling most often leaves bald or patchy spots, which in turn causes significant distress and can interfere with social or work functioning. People with trichotillomania often have to be very creative with hairstyles that may hide or disguise the hair loss.
For some people, trichotillomania may be mild and generally manageable. For others, the compulsive urge to pull hair is overwhelming. Some treatment options have helped many people reduce their hair pulling or stop entirely.
Symptoms of Trichotillomania
The primary feature of trichotillomania is recurrent pulling of one’s own hair. Hair pulling can occur in any region of the body in which hair grows; the most common sites include the scalp, eyebrows, and eyelids. Less common areas include facial, pubic, and peri-rectal regions.1
Other symptoms can include the following:
- Repeated attempts to decrease or stop hair pulling
- Hair pulling causes distress or impairment in social, occupational, or other areas of functioning
- An increasing feeling of tension before the hair pulling, or when trying to resist pulling
- A feeling of relief after pulling
- Noticeable hair loss
- Playing with pulled hair, or rubbing it across the face or skin
- Biting, chewing, or eating pulled hair
- Pulling certain kinds of hair (certain textures)
- Hair pulling often occurs in private
Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.
For people with trichotillomania, hair pulling can be:
- Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
- Automatic. Some people pull their hair without even realizing they're doing it, such as when they're bored, reading or watching TV.
The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.
Trichotillomania can be related to emotions:
- Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.
- Positive feelings. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.
Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.
What Causes Trichotillomania?
The exact cause of trichotillomania isn't known. It may be related to abnormalities in brain pathways that link areas involved in emotional regulation, movement, habit formation, and impulse control.
How Is Trichotillomania Diagnosed?
Trichotillomania is diagnosed based on the presence of its signs and symptoms. There is no specific test for it.
A doctor might refer someone who has symptoms of trichotillomania to a psychiatrist or psychologist, who can interview the person and see if they might have an impulse control disorder.
These factors tend to increase the risk of trichotillomania:
- Family history. Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.
- Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 10 and 13 years — and it's often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.
- Other disorders. People who have trichotillomania may also have other disorders, such as depression, anxiety or obsessive-compulsive disorder (OCD).
- Stress. Severely stressful situations or events may trigger trichotillomania in some people.
Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.
Although it may not seem particularly serious, trichotillomania can have a major negative impact on your life. Complications may include:
- Emotional distress. Many people with trichotillomania report feeling shame, humiliation and embarrassment. They may experience low self-esteem, depression, anxiety, and alcohol or street drug use because of their condition.
- Problems with social and work functioning. Embarrassment because of hair loss may lead you to avoid social activities and job opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
- Skin and hair damage. Constant hair pulling can cause scarring and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled and can permanently affect hair growth.
- Hairballs. Eating your hair may lead to a large, matted hairball (trichobezoar) in your digestive tract. Over a period of years, the hairball can cause weight loss, vomiting, intestinal obstruction and even death.