Trichotillomania (Hair Pulling Disorder)

Trichotillomania, also known as hair pulling disorder, is a debilitating mental condition characterized by the irresistible urge to pull out one’s own hair. This repetitive behavior often leads to hair loss and significant functional impairment. Similar to obsessive-compulsive disorder (OCD), individuals with trichotillomania experience an overwhelming compulsion to pull their hair, which can cause distress and negatively affect their daily lives.

What is the clinical picture of trichotillomania?

Signs of trichotillomania can be observed in any hairy region of the body, but the scalp remains the most common site (72.8%) followed by the eyebrows (56.4%) and the pubic region (50.7%). Patients describe multiple triggers that cause them to pull on their hair, such as:

  • Sensory stimulus: for example, hair thickness, length, location, and physical sensation of hair on the scalp,
  • Emotional stimulus: for example, anxiety, boredom, stress, or anger, and
  • Cognitive stimulus: for example, concerns about hair and appearance, rigid thinking, and cognitive errors, etc.

According to research, typically most individuals report a variety of these trigger which may even change day to day. Some individuals also report a phenomenon called Automatic pulling or focused pulling, where they are not even aware of their hair pulling behaviour.

Patients suffering from trichotillomania may also experience low self-esteem, pychosocial dysfunction, and social anxiety, all which further contribute to the habbit. Sadly, studies document that nearly one third of trichotilliomanic sufferers have a low or very low quality of life.

Trichotillomania is also found to exist with a variety of other psychiatric disorders, such as major depressive disorder (39%−65%), anxiety disorders (27%−32%), and substance abuse disorders (15%−19%). A survey conducted on 894 individuals with trichotillomania reported that 6.0% of the participants used illegal drugs, 17.7% tobacco products, and 14.1% sought alcohol to relieve negative feelings associated with hair pulling. Additionally, 83% of the participants reported anxiety and 70% exhibited signs and symptoms of depression secondary to trichotillomania.

The Cycle of Hair Pulling: Symptoms and Causes

People with trichotillomania may pull their hair from various areas, including the scalp, eyebrows, and eyelashes. The urge to pull hair can be triggered by sensory, emotional, or cognitive stimuli, such as the thickness, length, or location of the hair, as well as feelings of anxiety, stress, or boredom. These triggers may vary from person to person and can be unpredictable. The repetitive hair-pulling behavior can result in bald patches, noticeable hair loss, and even permanent hair loss if left untreated.

Fidget Toys: Fidget toys can provide a distraction and help redirect the urge to pull hair. Items like fidget spinners, stress balls, or sensory toys can be beneficial.


Consequences of Trichotillomania: Psychological and Emotional Impact

Trichotillomania often has profound psychological and emotional effects on individuals. They may experience low self-esteem, embarrassment, and a compromised body image. The visible signs of hair loss can lead to social anxiety and feelings of shame. Studies have shown that a significant number of people with trichotillomania also suffer from co-existing psychiatric disorders, such as major depressive disorder, anxiety disorders, and substance abuse disorders. These additional challenges further contribute to the overall impact on their quality of life.

Hair Growth Supplements: Supplements that promote healthy hair growth and strengthen hair follicles can be useful for individuals experiencing hair loss due to trichotillomania.

The Importance of Diagnosis and Treatment

Recognizing and addressing trichotillomania is crucial for individuals to regain control over their hair-pulling behaviors and improve their well-being. However, many people with trichotillomania may struggle to acknowledge their condition or feel ashamed, which can hinder their willingness to seek treatment. It is essential to raise awareness about trichotillomania and promote understanding to encourage affected individuals to seek the help they need.

Eyebrow and Eyelash Enhancers: Products such as serums or conditioners specifically designed to enhance the growth and appearance of eyebrows and eyelashes can be relevant for those who have pulled out hair from these areas.


Psychotherapy: A Key Component in Trichotillomania Treatment

Psychotherapy, particularly habit reversal therapy, has proven to be an effective approach in managing trichotillomania. This therapy helps individuals develop self-awareness of their hair-pulling behaviors, identify triggers, and learn alternative coping strategies. Habit reversal therapy is often complemented by acceptance and commitment therapy and dialectical behavior therapy, which further enhance treatment outcomes.

Habit Tracking Tools: There are various habit tracking apps and devices available that can help individuals monitor their hair-pulling behavior, set goals, and track progress over time.


Pharmacotherapy: Medications for Symptom Management

While pharmacotherapy is not considered a first-line treatment for trichotillomania, certain medications may be prescribed to help manage symptoms. Tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and glutamatergic agents have shown varying levels of effectiveness in reducing hair-pulling urges. However, medication should always be prescribed and monitored by healthcare professionals.

Stress Relief Products: Since stress and anxiety often contribute to hair-pulling urges, products that aid in relaxation and stress reduction can be beneficial. This can include items like essential oil diffusers, stress relief toys.


Living with Trichotillomania: Challenges and Coping Strategies

Trichotillomania can be a chronic condition, and individuals may experience periods of remission and relapse. Long-term management is crucial to prevent relapses and promote overall well-being. Joining support groups, maintaining open communication with healthcare providers, and implementing self-care practices, such as stress management techniques, can provide ongoing support and help individuals cope with the challenges of living with trichotillomania.

Wigs and Hairpieces: For individuals experiencing noticeable hair loss or bald patches, wigs and hairpieces can provide a temporary solution and help boost confidence.



Evidence exhibits behavioral therapy to be the preferred form of psychotherapy to tackle trichotillomania. Generally, habit reversal therapy and its components of acceptance and commitment therapy and dialectical behavior therapy show improved outcomes in such patients.

Habit reversal therapy was initially introduced for the treatment of nervous habits and tics, however, it is now also employed to manage conditions such as OCD and trichotillomania. The two key aspects of habit reversal therapy include self-monitoring, (where the patient is asked to keep track of his/her hair pulling, picking, etc.), and second awareness training, (modifying the environment that reduces cues for hair pulling). This therapy produces results that are generally maintained from 3 to 6 months. Although several combination therapies are typically applied in a clinical setting, the statistical data supports habit reversal therapy as the first-line psychotherapy treatment for trichotillomania. A retrospected review of 63 patients suffering from trichotillomania managed via psychotherapy demonstrated quality scores that were in the moderate to good range.

Adult‐onset trichotillomania may often be associated with other psychiatric disorders, and benefits from the treatment carried out for the co-existing condition.

Self-help Books and Workbooks: There are several self-help books and workbooks available that focus on managing hair-pulling disorders, providing coping strategies, and promoting self-awareness.


FAQs on Trichotillomania: Understanding Hair Pulling Disorder

What is trichotillomania?

Trichotillomania is a hair pulling disorder characterized by the irresistible urge to pull out one’s hair, which can result in noticeable hair loss.

What are the symptoms and causes of trichotillomania?

The symptoms of trichotillomania include the recurrent pulling of hair, the inability to stop pulling, noticeable hair loss, and significant distress. The disorder may occur due to a combination of genetic and environmental factors.

How common is trichotillomania?

Trichotillomania is relatively common, and many people with the disorder often find it difficult to resist the urge to pull their hair. It is considered an impulse control disorder and is often associated with other psychiatric conditions, such as obsessive-compulsive and related disorders.

Can trichotillomania be treated?

Yes, trichotillomania can be treated. Treatment for trichotillomania may include a combination of therapies, such as cognitive-behavioral therapy, pharmacotherapy, and other management strategies tailored to the individual’s needs.

What are the available treatment options for trichotillomania?

The treatment of trichotillomania may involve various approaches, including behavioral therapies, such as habit reversal training, and pharmacotherapy using medications specifically prescribed for impulse control disorders like trichotillomania.

Can trichotillomania cause permanent hair loss?

In severe cases of trichotillomania, where hair pulling is persistent, permanent hair loss can occur. This is why early diagnosis and treatment are crucial to prevent long-term damage.

Is trichotillomania associated with other disorders?

Yes, trichotillomania is often seen in conjunction with other psychiatric disorders, such as obsessive-compulsive disorder (OCD), anxiety disorders, and skin picking disorder. This highlights the importance of a comprehensive diagnosis and treatment approach.

What are some triggers for trichotillomania?

Triggers for trichotillomania can vary from person to person and may include emotional factors like stress, anxiety, and boredom, as well as sensory factors related to the hair’s thickness, length, or location.

Can trichotillomania be diagnosed and treated?

Yes, trichotillomania can be diagnosed and treated. Seeking professional help, such as from a mental health specialist or a dermatologist, can lead to an accurate diagnosis and the development of a personalized treatment plan.

How can someone manage the urges to pull hair?

Managing the urges to pull hair in trichotillomania involves various techniques, such as identifying triggers, finding alternative behaviors or activities to engage in when the urge arises, and seeking support from therapists or support groups.

Can trichotillomania affect areas other than the scalp?

Yes, trichotillomania can affect areas other than the scalp. It can involve pulling hair from eyebrows, eyelashes, and other regions of the body.

Is there a connection between trichotillomania and skin picking disorder? Trichotillomania and skin picking disorder, also known as dermatillomania, are both related to compulsive behaviors. While they are separate disorders, individuals with trichotillomania may also experience skin picking tendencies.

Can swallowing hair be a problem in trichotillomania?

Swallowing hair, known as trichophagia, can be a potential problem in trichotillomania. It may lead to complications such as abdominal discomfort, nausea, vomiting, and, in rare cases, gastrointestinal blockages.

What should I do if I suspect I have trichotillomania? If you suspect you have trichotillomania, it is important to seek professional help. A mental health specialist can provide a proper diagnosis and guide you through the appropriate treatment options available.



Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair-pulling). New England Journal of Medicine. 1989 Aug 24;321(8):497-501.

Swedo SE, Leonard HL. Trichotillomania: an obsessive-compulsive spectrum disorder?. Psychiatric Clinics. 1992 Dec 1;15(4):777-90.

Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair-pulling). New England Journal of Medicine. 1989 Aug 24;321(8):497-501.

du Toit PL, van Kradenburg J, Niehaus DJ, Stein DJ. Characteristics and phenomenology of hair-pulling: an exploration of subtypes. Comprehensive psychiatry. 2001 May 1;42(3):247-56.

Swedo SE, Leonard HL. Trichotillomania: an obsessive-compulsive spectrum disorder?. Psychiatric Clinics. 1992 Dec 1;15(4):777-90.

Woods DW, Flessner CA, Franklin ME, Keuthen NJ, Goodwin RD, Stein DJ, Walther MR. The Trichotillomania Impact Project (TIP): exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry. 2006 Dec 1;67(12):1877.

Christenson GA. Trichotillomania: from prevalence to comorbidity. Psychiatric Times. 1995;12(9):44-8.

Odlaug BL, Kim SW, Grant JE. Quality of life and clinical severity in pathological skin picking and trichotillomania. Journal of Anxiety Disorders. 2010 Dec 1;24(8):823-9.

Siddiqui EU, Naeem SS, Naqvi H, Ahmed B. Prevalence of body-focused repetitive behaviors in three large medical colleges of Karachi: a cross-sectional study. BMC research notes. 2012 Dec;5(1):1-6.

Rothbart R, Amos T, Siegfried N, Ipser JC, Fineberg N, Chamberlain SR, Stein DJ. Pharmacotherapy for trichotillomania. Cochrane Database of Systematic Reviews. 2013(11).

Keuthen NJ, O’Sullivan RL, Goodchild P, Rodriguez D, Jenike MA, Baer L. Retrospective review of treatment outcome for 63 patients with trichotillomania. American Journal of Psychiatry. 1998 Apr 1;155(4):560-1.

Rehm I, Moulding R, Nedeljkovic M. Psychological treatments for trichotillomania: Update and future directions. Australasian Psychiatry. 2015 Aug;23(4):365-8.

Bloch MH, Landeros-Weisenberger A, Dombrowski P, Kelmendi B, Wegner R, Nudel J, Pittenger C, Leckman JF, Coric V. Systematic review: pharmacological and behavioral treatment for trichotillomania. Biological psychiatry. 2007 Oct 15;62(8):839-46.

Sah DE, Koo J, Price VH. Trichotillomania. Dermatologic therapy. 2008 Jan;21(1):13-21.

Grant JE, Chamberlain SR. Trichotillomania. American Journal of Psychiatry. 2016 Sep 1;173(9):868-74.