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Trichotillomania - Causes, Symptoms, Diagnosis, and Treatment

Published on Dec 07, 2020   -  4 min read


Trichotillomania is a hair-pulling disorder. Read this article to know more about causes, symptoms, diagnosis, and treatment.

Trichotillomania - Causes, Symptoms, Diagnosis, and Treatment

What is Trichotillomania?

Trichotillomania is commonly known as hair-pulling disorder. It is a psychological disorder that comes under the category of obsessive-compulsive disorder. It involves an uncontrollable urge to pluck or pull the hair in the scalp, or hair from the eyebrows, eyelashes, and private parts. Pulling of hair from the scalp might cause patches in the scalp. This condition is usually very mild, but can be moderate to severe in untreated or chronic cases.

What Are the Symptoms?

Trichotillomania has a characteristic obsession in thoughts to do a particular behavior in general. Performing such activities, again and again, will give the patient psychological relief. The patient may or may not be aware of their repetitive behaviors. If the behavior is appropriate according to the environment, then it is known as syntonic. If the behavior is not in alignment with the needs of the self, or to the environment, then it is known as dystonic. Trichotillomania is often known to be dystonic. The patient’s excessive urge to pull hair might be inappropriate in a social set-up. If the patient identifies their repetitive behavior, it might be easy for the doctor to treat the patient. If the patient is totally unaware of his own condition, the treatment might require time. The other notable symptoms are:

Whom Does It Affect?

Irrespective of gender, trichotillomania can affect both males and females. Pre-school children and young adults are commonly affected. African women are known to be affected more than other races. Trichotillomania is known to have an association with a borderline personality disorder. Patients who are affected by borderline personality disorder are known to develop trichotillomania as a self-harming behavior. The tendency to hurt oneself will be higher in borderline patients, and the act of pulling hair will be done by these patients as a compensatory deed for emotional trauma. The extensive emotional rides these patients face will make them depend on unhealthy coping habits. When borderline personality disorder coexists with trichotillomania, then such a condition is comorbidity.

What Are the Causes?

The common causes of trichotillomania are:

  1. Poor parenting in childhood.

  2. Traumatic family relationships.

  3. Low self-esteem.

  4. Post-traumatic stress disorder.

  5. Family history.

  6. Genetics.

  7. Anxiety and depression.

  8. Emotional trauma.

What Are the Types of Trichotillomania?

Based on whether the person is mindful about the behavior or not, trichotillomania can be classified into two categories:

Automatic: In automatic type, the person carelessly runs his fingers over the hair. This may be casually done while reading a book or watching the T.V.

Focused: In this type, the patients do it as a ritual for a prolonged duration. This may be accompanied by biting and chewing the hair.

How Is It Diagnosed?

Trichotillomania is very difficult to diagnose as the patient refuses to agree with their behavior. This might be due to the shy or guilt feeling the patient has. Trichotillomania is often misdiagnosed with other conditions. A biopsy result might be helpful in a few cases as it may detect perifollicular hemorrhage or defective hair patterns. Empty hair follicles can be an indicative sign of Trichotillomania. Diagnosis requires a skilled psychiatrist or psychologist to identify the condition.

What Are the Treatment Options?

The treatment options vary according to the age of the patient. It might be any medication or psychotherapy treatment.


The tricyclic antidepressant drug such as Clomipramine is given for trichotillomania patients. This medication is not available over-the-counter and should be taken only after the doctor’s guidance.

Biofeedback: This process helps to gain control over the involuntary muscles. It helps a person to achieve awareness of their own body. It involves both auditory and visual feedback mechanisms. It helps to improve the overall functioning and health of the individual.

Cognitive-Behavioral Therapy: It is a well known psychological and therapeutic method to improve the mental health status of the patients. Self-cbt practices and books are available. However, when it is guided by professional psychotherapists, the improvement will be beneficial. With the help of cbt, thoughts, behaviors, and emotions can be brought to proper alignment.

Habit Reversal Training: Habit reversal training involves engaging the patient to identify the patient’s negative behavior, increasing their awareness about the patient’s performance and urges. This technique helps the patient to cope up with the compulsive thoughts and actions. This training method requires support from parents, teachers, and friends.

Acceptance and Commitment Therapy: This therapy is used to overcome workplace issues and stress. The importance of radical acceptance will be emphasized in this therapy. Certain intellectual thoughts will be educated so that the person does not behave only according to his emotions and urges. Self-observation will be taught, and committed actions that are healthy will be educated.

How Is the Prognosis?

Prognosis is usually good for patients below five years of age. Infants do not need any treatment protocol. The rate of prognosis is poor in patients above five years because trichotillomania in such patients may be a sign of other psychiatric illnesses. This is the best treatment option for substance abuse and chronic pain.

What Is the Differential Diagnosis?

  1. Iron deficiency.

  2. Hypothyroidism.

  3. Thallium poisoning.

Are you suffering from trichotillomania? Call a doctor online.


Frequently Asked Questions


Does Trichotillomania Go Away?

Yes, trichotillomania can go away with proper treatment. Patients who experience severe symptoms of trichotillomania require professional help from a psychologist. It is a condition that does not get resolved on its own.


Is Trichotillomania a Type of OCD?

Trichotillomania can happen as a manifestation of obsessive-compulsive disorder. It is not an actual type of OCD disorder. Patients who have obsessive thoughts tend to keep pulling their hair to get a certain degree of psychological satisfaction.


Why Does Pulling Hair Feel Good?

Improper functioning of the neurotransmitter can cause an urge in a person to pull hair constantly. This act of hair pulling is known to give the patients psychological satisfaction and make them feel good. They might do it knowingly or unknowingly.


What Is the Best Treatment for Trichotillomania?

The best treatment options for trichotillomania include psychotherapy treatment like the following.
- Cognitive-behavioral therapy.
- Acceptance and commitment therapy.
- Habit reversal training.
A qualified psychologist or psychiatrist performs these methods.


Does Pulled Out Hair Due to Trichotillomania Grow Back?

Yes, the hair that is lost in trichotillomania can grow back. If the patient is having severe symptoms, then the growing back of hair requires special treatment options. You can get help from your trichologist to improve growth. In addition to this, psychological counseling is required.


How to Help Someone With Trichotillomania?

Patients with trichotillomania can be treated with medications and psychological treatment. If the person suffering is a close family member, you have to provide them comfort and care. You should not make them feel inferior for their behavior. Emotional support is more important for these patients.


Is Trichotillomania a Hereditary Condition?

Yes, trichotillomania can be a hereditary condition. Genetic mutations are also known to be the causative factor for trichotillomania. Siblings who have trichotillomania have the highest possibility of passing the condition to other siblings. A poor parenting style might also be the cause.


How Does Trichotillomania Affect the Brain?

Trichotillomania is known to reduce the white matter of the brain. There is dysfunction in the neurotransmitter mechanism of the brain. The frontal cortex of the brain is known to become abnormally thick. Trichotillomania is also considered a neuropsychiatric condition.


Is Trichotillomania a Disease?

Yes, trichotillomania is a neuropsychiatric condition in which the patient experiences an excessive urge to pull out the hair. This might involve hair on the head and all the hair on the body, such as eyebrows, pubic hairs, eyelashes, arms, and scalp.


What Is the Best Medication for Trichotillomania?

The medications that are helpful in treating trichotillomania are:
- Fluoxetine.
- Fluvoxamine.
- Sertraline.
- Citalopram.
- Escitalopram.
- Paroxetine.
It is better to take medications if your doctor recommends you to do so.


Can You Get Rid of Trichotillomania Permanently?

The permanent cure for trichotillomania is possible only after long term treatment. The patient has to cooperate well for psychological counseling and associate treatment methods. If the doctor recommends medications, the patient has to go for them regularly in the prescribed dosage.


Why Do I Have Trichotillomania?

Trichotillomania can happen due to emotional stress and anxiety. It can also be due to genetic mutations and hereditary causes. Patients having obsessive-compulsive disorder are known to be affected by trichotillomania. Hormonal changes happening in puberty can cause trichotillomania.


How Serious Is Trichotillomania?

In some patients, trichotillomania is not a very severe condition as the patients try pulling the hair only in rare instances. It is not serious in such conditions. If the habit of pulling hair is disturbing the individual's regular routine, then it is necessary to take immediate treatment.


How Do I Stop Pulling My Hair Out?

A good coping up and diversion from hair pulling will help in overcoming the trichotillomania. The coping up is different for each and every individual. Some find music as a good diversion while others find sports as a good option. It is necessary to find out which works best for you.


What Can I Do Instead of Pulling My Hair?

You can follow the below tips to stop pulling the hair.
- Squeezing a stress ball.
- Regular exercise.
- Put plasters to your fingers.
- Practice breathing exercises.


What Triggers Trichotillomania?

Trichotillomania is triggered by stressful situations and anxiety attacks. They are also triggered by verbal abuse or insult. Loneliness can trigger trichotillomania in an individual. The triggers might vary from one person to another. It is important to identify the triggers in the earlier stage to prevent further complications.

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Last reviewed at:
07 Dec 2020  -  4 min read




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