Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 10/10/2021
According to Merriam-Webster, the word trichotillomania comes from the Greek trich-, which means “hair,” and tillein, “to pull or pluck.”
Sometimes called “trich” for short, trichotillomania is a mental health condition where a person compulsively pulls out their own body hair.
Occurring in less than four percent, of adults, individuals with this mental health disorder contend with the irresistible urge to pull their own hair out, regardless of their desire to stop.
The intensity of the desire to hair-pull is known to fluctuate over time.
Hair pulling as a result of trichotillomania occurs most frequently at the scalp, but can occur anywhere hair may grow on the body and is otherwise most common in the eyebrows and pubic region.
Over time, patients with trichotillomania may experience noticeable hair loss, as well as feelings of shame or embarrassment about their condition.
Let’s jump into the diagnosis of trichotillomania, symptoms and available treatments.
Trichotillomania was first published in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1987, where it was classified as an impulse control disorder.
In 2013 when the most recent edition of the book was published, the condition was moved to the chapter on obsessive-compulsive and related disorders.
The age of onset for trichotillomania usually happens between the ages of 10 and 13 years old. While the condition is observed with equal prevalence in girls and boys, in adults it is four times more frequent in women as compared to men.
The diagnosis criteria for trichotillomania is:
Recurrent pulling out of your own hair, resulting in hair loss
Repeated attempts to stop or at least decrease instances of hair pulling
Significant distress or impairment in occupational or social situations, and other important areas of functioning due to hair pulling
Lack of other medical conditions related to hair pulling or hair loss (such as a skin condition)
Lack of other mental disorders related to hair pulling or hair loss
It’s worth noting that although trichotillomania is a separate condition from obsessive-compulsive disorder (OCD), it is often misdiagnosed as such due to the repetitive nature of the hair pulling, and it being similar to the repetitive compulsive behaviors seen in individuals with OCD.
The similarities between the two conditions are further underpinned by a higher prevalence of OCD in individuals with trichotillomania compared to the general population.
The majority of individuals this with hair-pulling disorder are reluctant to seek help due to feelings of shame or embarrassment around the condition, and the belief that medical providers will not know how to treat them.
The medical community remains unsure of what exactly causes trichotillomania. Ideas for potential causes include:
Stress and anxiety
A chemical imbalance in the brain
Puberty-driven hormonal changes
While direct causation is uncertain, there do exist risk factors for trichotillomania.
Outside of the condition’s prevalence in adult women, people with trichotillomania are more likely to have a relative with trichotillomania, mood or anxiety disorders and engage in body-focused repetitive behaviors like skin picking or compulsive nail biting.
In both adults and children, it is common to see at least one other mental health disorder alongside trichotillomania.
In adults, these include disorders of anxiety, mood, substance use, eating, and personality. In children, anxiety disorders are commonly observed.
The reason for hair pulling is another area of uncertainty.
From a psychological perspective, the behavior may serve as a method for regulating emotional states or navigating emotional distress, serving as a way of releasing tension. Boredom may also be a trigger for hair-pulling behavior.
Aside from the aforementioned feelings of shame and embarrassment, trichotillomania has physical impacts, including,:
Bald spots at the hair-pulling location
Skin irritation & infections where hair is pulled
Repetitive-use hand injuries
Hairball-induced gastrointestinal issues due to an individual consuming their hair after having pulled it (over twenty percent of trich cases)
Whilte treatment for trichotillomania is under-researched, the most promising is cognitive behavioral therapy, with a particular focus on habit reversal therapy.
Cognitive behavioral therapy as a whole is focused on the identification of deeply held unhelpful or negative beliefs, with the goal of examining them in a more realistic light.
Habit reversal training is centered around self-monitoring of hair-pulling behavior, awareness training and stimulus control, which is a way of monitoring one’s environment to avoid hair-pulling triggers.
Medications such as selective serotonin reuptake inhibitors (SSRIs) can also be used to treat trichotillomania, but there is no universally accepted standard for this approach.
Individuals who are treated for the condition will often receive a combination of treatment that includes both therapy and medication.
Lastly, in individuals who consume their hair after pulling it, a condition known as trichophagia, medical providers will be on the lookout for trichobezoars or hairballs.
Most individuals who eat their hair do not develop hairballs, they can present complications as severe as death once formed.
Signs of hairballs include chest discomfort, abdominal pain, vomiting, unexplained weight loss, change in stool color, diarrhea or constipation.
While trichotillomania is a rare condition, treatment options do exist.
Most individuals do not see improvement without treatment, but with early diagnosis and appropriate treatment, up to 50 percent of individuals report improvement in the short term.
If you suspect that you may have trichotillomania, reach out to your medical provider to talk about your treatment options.
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