What is Trichotillomania? A Look at the Excessive Pulling of Hair

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Hair is pulled from the scalp, eyebrows, arms, legs, pubic area and/or any other area on the body where there is hair. The method for pulling hair out, is typically done with the fingers, however, some individuals will use items such as tweezers. The crown area of the scalp, is the primary area where individuals with trichotillomania begin pulling hair from. Over an extended period of time they will develop large bald spots on their head. In attempt to avoid additional bald spots, they will often begin pulling the hair from other parts of the body. To further answer the question what is trichotillomania we will focus our attention on signs, symptoms and psychological effects.

What is Trichotillomania? Signs and Symptoms

Trichotillomania typically has an onset age of approximately twelve or thirteen, although it can begin later or earlier. It has also been shown that an extremely stressful is typically the trigger for hair pulling to begin.

Primary symptoms include significant hair loss due to the person pulling their hair out, missing or bare areas on eyebrows and/or eyelashes, bald or patchy spots on various areas of the body, rubbing the lips or face with hair that has been pulled out, continuous playing with hair and chewing or eating pulled out hair. The individual with trichotillomania will often display an increase in tension or stress, immediately prior to pulling hair. They will also have a display of gratification or pleasure as well as relief during and after pulling out the hair.

Psychological Effects

There is often a tremendous amount of shame and/or guilt associated with the symptoms, as well as the after effects (the baldness). People with this condition tend to perform their hair pulling behaviors in private. The majority of sufferers feel as though they are the only ones with this problem. They will often wear hats, scarves and wigs, or style their hair in a fashion that will not bring attention to the loss of hair.

A decrease in social interactions often occurs, due to the embarrassment the individual feels from the noticeable hair loss. It is not uncommon for people with this diagnosis to become depressed, anxious and/or develop low self-esteem. Though the individual may not have previously been diagnosed with a mental illness, the effects of the trichotillomania will often lead to them seeking help for the depression and/or anxiety. This being the time when the symptoms of trichotillomania are discovered.

Therapy and Medication

The symptoms of this disorder often mimic those of an obsessive compulsive disorder. The obsession being pulling the hair and the compulsion is to follow through with it.

Due to the similarity in symptoms between trichotillomania and OCD, the medications and therapy treatments for OCD are used to treat those with trichotillomania. Cognitive behavior therapy and its components have been shown to be effective forms of treatment. Medication is typically used with therapy, as opposed to it being the only form of treatment.

Habit reversal training (HRT), a component of cognitive behavior therapy, is an effective form of treatment. The tools utilized with this type of therapy teach the individual how to become aware of the hair pulling and to ultimately reverse their habits. They learn the triggers and/or emotions that may set the hair pulling behavior in motion. Throughout the therapy sessions the individual will learn to identify the triggers and replace the behavior with positive substitution behaviors. The individual learns to accept the urge to pull their hair, identify the urge as an impulse and to finally learn how to avoid acting on impulse.

Medication treatment alone is not effective in preventing the hair pulling. However, anti-depressants and/or anti-anxiety medications are often used to treat the symptoms of depression and anxiety that often accompany the trichotillomania.


Trichotillomania Learning Center Mayo Clinic https://www.mayoclinic.com/health/trichotillomania/DS00895/DSECTION=treatments-and-drugs

Mental Health America https://www.nmha.org/go/information/get-info/trichotillomania https://trich.org/