Trichotillomania – Symptoms and Causes

Overview

Trichotillomania, also known as hair-pulling disorder, is a mental health condition. People with this condition often feel an uncontrollable urge to pull out their hair. They usually pull hair from their scalp, eyebrows, or other body areas.

This disorder belongs to a category called body-focused repetitive behaviors.

The repeated hair pulling usually creates patchy bald spots, especially on the scalp. These visible changes can cause significant distress and may interfere with daily functioning in work, school, and social settings. Many individuals go to considerable lengths to hide their hair loss.

The severity of trichotillomania varies among those affected. Some people experience milder symptoms that can be managed effectively, while others face overwhelming automatic or deliberate urges to pull their hair. This can cause substantial emotional distress.

With proper support and treatment, many people can gain control over this condition.

Signs and Symptoms

People with hair-pulling disorder show several common symptoms. They repeatedly pull out hair from their scalp, eyebrows, eyelashes, or other body areas. The places they pull from may change over time.

Before pulling, they often feel tension building up. This tension goes away after pulling out the hair, replaced by a feeling of relief or even pleasure.

Hair loss becomes visible with thinned areas or bald patches. Some people pull in specific patterns or follow certain routines each time they pull.

Many people with this condition also bite, chew, or eat the pulled hair. Others play with it or rub it across their face.

Despite trying to stop or reduce hair pulling, most find it difficult to control the urge. The condition causes significant distress and can create problems at work, school, or in relationships.

Related behaviors might include skin picking, nail biting, or lip chewing. Sometimes people pull hair from pets, dolls, or fabrics like blankets or clothing.

Hair pulling usually happens in private and can last from seconds to hours. Many people try to hide their condition from others.

There are two main types of hair pulling:

• Automatic pulling happens without awareness – while watching TV, reading, or during other activities.
• Focused pulling is done deliberately to relieve tension or distress, often with specific rituals.

Most people experience both types, depending on their situation and mood. Certain positions (like resting your head on your hand) or activities (like brushing your hair) may trigger pulling episodes.

The condition connects strongly to emotions:

• Negative Feelings: Hair pulling can be a way to cope with stress, anxiety, boredom, loneliness, or frustration.
• Positive Feelings: The relief or satisfaction from pulling creates a reward that reinforces the behavior.

Without treatment, this disorder typically continues long-term. Symptoms may come and go or vary in intensity. For some women, hormone changes during menstruation can worsen symptoms.

Only rarely does the condition stop on its own within a few years of starting.

When to Seek Medical Help

If you find yourself unable to stop pulling your hair, or if the condition causes embarrassment or shame about your appearance, it’s important to speak with a healthcare provider.

This isn’t simply a bad habit you need to break through willpower – it’s a recognized mental health condition that typically requires proper treatment to improve.

Causes

The exact cause of trichotillomania remains unclear. Research suggests this hair-pulling disorder likely stems from a mix of genetic factors and learned behaviors. Scientists believe that both inherited traits and environmental influences play important roles in its development.

Risk Factors

Several factors may raise someone’s chances of developing trichotillomania:

Genetic Factors

• Family history plays a role
• Having close relatives with the condition increases risk

Physical Discomfort

• Uncomfortable skin or hair conditions may trigger pulling behaviors
• Focus on hair or scalp can lead to repetitive pulling

Age-Related Patterns

• Most often begins between ages 10-13
• Can become a long-term condition
• Infant hair pulling typically resolves without treatment

Connected Mental Health Issues

• Often occurs alongside depression, anxiety, or OCD
• These conditions may worsen hair-pulling behaviors

Stress and Environment

• High stress levels can trigger episodes
• Boredom and isolation increase pulling behaviors
• Private settings may enable more frequent pulling

While treatment statistics show more women seek help for trichotillomania, the actual occurrence rates in early childhood are equal between boys and girls. This suggests a potential gender difference in help-seeking behavior rather than in the condition itself.

Complications

Trichotillomania may seem minor but can lead to serious problems. People with this condition often face emotional challenges.

They might feel shame, frustration, and loss of control. This can lead to low self-esteem, depression, and anxiety. Some turn to alcohol or drugs to cope.

The visible hair loss can disrupt daily life. Many avoid social gatherings or new opportunities at work or school.

Some wear wigs, style hair differently, or use false eyelashes to hide bald spots. Fear of discovery may cause them to avoid close relationships.

Physical Damage

• Scarring of the scalp or affected areas
• Skin infections
• Permanent hair loss in damaged areas
• Disrupted hair growth patterns

The repeated pulling can cause lasting damage to the skin and hair follicles. This may permanently affect how hair grows in those areas.

A dangerous but rare complication occurs when people eat the hair they pull out. This can form a hairball (trichobezoar) in the digestive system. Over time, these hairballs can cause:

• Weight loss
• Vomiting
• Intestinal blockage
• Potentially fatal complications if untreated