Trichotillomania: Definition, Symptoms, Causes, Effect, and Treatment

Published On September 26, 2024 | Last Updated: September 26, 2024

Trichotillomania, also known as hair-pulling disorder, is a mental health condition that involves a constant and irresistible urge to pull out hair from your scalp, eyebrows, eyelashes, or other areas of the body. This behavior results in visible hair loss and can cause chaos and distress in social, work, personal, or other important areas of life.

The signs and symptoms of trichotillomania include repetitive hair pulling, increasing tension before hair pulling, emotional distress, repeated attempts to stop hair pulling, bald patches or thinning hair, and emotional and behavioral symptoms.

The causes of trichotillomania are not fully understood but can be a combination of genetic, biological, environmental, and psychological factors. Stress, anxiety, and certain personality traits may also contribute to the development of the disorder.

Trichotillomania can cause various effects, like noticeable hair loss, bald patches, and even skin damage or infections. This can further lead to emotional distress, social withdrawal, and a negative impact on self-esteem and quality of life.

Treatment for trichotillomania involves a combination of therapy and medication. Affected people are advised to join support groups, opt for cognitive behavioral therapy (CBT), and manage stress through exercises, deep breathing, and the mantra technique. Medications like selective serotonin reuptake inhibitors (SSRIs) also help manage symptoms.

What is Trichotillomania?

Trichotillomania, known as a hair-pulling disorder, is a chronic mental health condition characterized by the urge to pull out your hair, resulting in noticeable hair loss and distress. According to the American Psychiatric Association (APA), trichotillomania is classified under Obsessive-Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The condition usually begins during early childhood and can move to adulthood if not properly treated.

The International OCD Foundation (IOCDF) describes that trichotillomania involves repetitive hair-pulling leading to an increasing and overwhelming urge. The act of hair-pulling further provides a sense of relief. The IOCDF also highlights that this behavior is not simply a habit but a mental health disorder that requires professional treatment.

According to the Anxiety and Depression Association of America, ADAA, approximately 5-10 million Americans show signs and symptoms of trichotillomania. Another study by the National Center for Biotechnology Information states that the lifetime prevalence of trichotillomania can be 1-3%, with females as the most affected gender.

What is the difference between trichotillomania and obsessive-compulsive disorder?

Trichotillomania and Obsessive-Compulsive Disorder (OCD) are both types of obsessive-compulsive and related disorders. However, the two types can affect individuals in different ways.

Trichotillomania is the irresistible urge to pull out hair from your body parts. This disorder is usually triggered by tension or anxiety, followed by a feeling of relief or pleasure once you pull out the hair. For example, people with trichotillomania may pull out hair during stressful situations or while feeling bored until bald patches appear. This behavior leads to distress in social, work, or personal lives.

On the other hand, Obsessive-Compulsive Disorder (OCD) involves unwanted thoughts and repetitive behaviors that people feel compulsory to perform. For example, a person with OCD can be obsessed with germs and cleanliness, and wash their hands repeatedly until they feel a sense of relief from their anxiety.

Despite these differences, there is a strong relationship between the two disorders. Both trichotillomania and OCD involve compulsive behaviors to reduce anxiety or stress. Trichotillomania only involves hair-pulling as a response to tension, and OCD involves many compulsions in response to specific and intrusive thoughts.

What is the relation between Trichotillomania and Skin-Picking Disorder?

Trichotillomania and Skin-Picking Disorder are both classified under Obsessive-Compulsive and Related Disorders in the DSM-5. They share similarities but have significant differences.

Trichotillomania is the compulsive urge to pull out your hair, leading to visible hair loss and distress. For example, an individual may pull hair from their scalp, eyebrows, or eyelashes, often because of stress or anxiety.

Skin-Picking Disorder involves repetitive picking at your skin, resulting in skin lesions and mental distress. For example, a person with this disorder can pick at healthy skin, minor skin irregularities, or scabs, leading to open sores and infections.

The two disorders are similar because of their compulsive nature and the emotional triggers behind the behaviors. Both disorders are triggered by anxiety or stress that is temporarily relieved after hair-pulling or skin-picking.

What are the Signs and Symptoms of Trichotillomania?

These signs and symptoms of trichotillomania are listed below.

Repetitive Hair Pulling: The main symptom of trichotillomania is the repetitive pulling of hair from the scalp, eyebrows, eyelashes, or other body parts. Research by Duke et al. (2010) highlights that this compulsion is usually because of an increasing sense of tension and a feeling of relief or pleasure once the hair is pulled out.
Increasing Tension Before Hair Pulling: Individuals often experience a buildup of tension or anxiety before the act of hair-pulling. This tension is a key characteristic of trichotillomania. The tension is usually relieved or reduced after the hair is pulled, providing a temporary sense of satisfaction.
Emotional Distress: Hair-pulling leads to significant emotional distress and can interfere with daily life. According to a study by Christenson et al. (1991), individuals with trichotillomania often feel embarrassed, ashamed, or frustrated by their inability to control their behavior.
Repeated Attempts to Stop Hair Pulling: People with trichotillomania usually make repeated efforts to decrease or stop the hair-pulling behavior but struggle to do so. The attempts usually fail until they seek professional help.
Bald Patches or Thinning Hair: Visible signs of hair loss, like bald patches or thinning hair, are common signs of trichotillomania.
Emotional and Behavioral Symptoms: People with trichotillomania experience different emotional symptoms, like feelings of guilt, shame, and anxiety. Behavioral symptoms may include avoiding social gatherings where people can notice their hair loss, wearing hats or wigs to cover bald spots, or spending most of their time on hair-pulling.

What are the Causes of Trichotillomania?

The causes of trichotillomania are a combination of genetic, biological, environmental, and psychological factors.

The causes of trichotillomania are listed below.

Genetic Factors: Genetic factors play an important role in the development of trichotillomania. Individuals with a family history of trichotillomania or other obsessive-compulsive disorders are more likely to develop the condition. Scientists at Duke University Medical Center identified two mutations in the SLITKR1 gene linked to trichotillomania, accounting for a small percentage of cases.
Biological Factors: Imbalances in brain chemicals like serotonin and dopamine can influence hair-pulling behaviors. Research by Stein et al. (2008) in the Journal of Neuropsychiatry and Clinical Neurosciences highlights the role of neurotransmitter dysfunctions in the development of trichotillomania.
Environmental Factors: Stressful life events and environmental factors can trigger trichotillomania in some individuals. A study by Flessner and Woods, 2006, indicates that high levels of stress or traumatic experiences can trigger hair-pulling behaviors.
Psychological Factors: According to a study by Diefenbach et al. (2000) in the Clinical Psychology Review, psychological factors like high levels of anxiety, depression, or mental health disorders play a significant role in the development of trichotillomania.

What are the Effects of Trichotillomania?

The most common effects of trichotillomania include physical damage, emotional distress, social isolation, and disturbance in daily activities.

These effects of trichotillomania are listed below.

Physical Damage: A study by Keuthen (2001) in the Journal of Psychosomatic Research states that persistent hair-pulling can lead to noticeable hair loss, bald patches, thinning hair, and skin damage. Infections and scarring can occur in severe cases.
Emotional Distress: Individuals often experience intense feelings of shame, guilt, and embarrassment due to their inability to control hair-pulling behaviors. According to a study by John. E. Grant and Samuel R., 79% of individuals with trichotillomania reported one or more other mental health conditions, like low self-esteem, depression, anxiety, or ADHD.
Social Isolation: The visible hair loss due to trichotillomania can cause people to avoid social interactions and public situations to hide their condition. This social withdrawal can lead to loneliness, sadness, and isolation.
Disturbance in Daily Activities: Trichotillomania can disturb daily activities and responsibilities, affecting academic performance, work, and overall functioning. Individuals may spend a significant amount of time only engaging in hair-pulling.

How does Trichotillomania affect your physical health?

Trichotillomania mainly affects the hair and skin, further leading to physical health issues. The main effect is hair loss, resulting in bald patches on the scalp and permanent damage to hair follicles, which can cause irreversible hair loss and scarring. Continuous hair-pulling also damages the skin, creating sores and increasing the risk of bacterial infections and permanent scarring.

How can Trichotillomania affect your mental health?

Trichotillomania affects mental health, particularly the brain. Individuals with this disorder often experience intense feelings of shame, guilt, and embarrassment due to their failed attempts to control hair-pulling. This emotional distress can lead to co-occurring mental health disorders like depression and anxiety. A study by Diefenbach (2005) clearly states that individuals with trichotillomania frequently suffer from low self-esteem and other psychological issues.

How is Trichotillomania Diagnosed?

The two main tests to diagnose trichotillomania are punch biopsy and a computerized tomography CT scan.

The tests for trichotillomania diagnoses are mentioned below.

Punch Biopsy

A punch biopsy is a dermatological procedure where a dermatologist removes a small and circular piece of skin, including all its layers, using a punch tool. This test helps in diagnosing trichotillomania by examining the hair follicles and surrounding skin tissue under a microscope to identify signs of damage from hair-pulling. It also helps to rule out other dermatological conditions like fungal infections or alopecia areata. The procedure is usually conducted under local anesthesia to make it relatively quick and minimally painful.

Computerized tomography (CT) Scan

A Computerized Tomography (CT) scan is an imaging procedure that uses a combination of X-rays and computer technology to produce detailed cross-sectional images of the body, including the brain. This test can help identify any abnormalities in the brain associated with impulse control and obsessive behaviors. The main brain regions they focus on are the frontal cortex and basal ganglia. The test is non-invasive and it requires the patient to remain still during the scanning process to ensure clear images.

What are the Types of Trichotillomania Treatment?

The treatment types of trichotillomania include cognitive behavioral therapy, joining a trichotillomania support group, managing stress, exercising, deep breathing, mantra, and medications.

These trichotillomania are described below.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for trichotillomania. CBT helps individuals identify and change negative thought patterns and behaviors associated with hair-pulling. The therapy often includes Habit Reversal Training (HRT), which teaches alternative behaviors to replace hair-pulling. However, this therapy can be time-consuming and requires a trained therapist.

Join a Trichotillomania Support Group

Trichotillomania support groups provide individuals with a sense of community and understanding, as they share experiences and coping strategies with others facing similar conditions. These groups can offer emotional support, reduce feelings of isolation, and provide practical advice for managing hair-pulling behaviors. The main advantages of support groups are mutual support, inclusion, and validation.

Manage Stress

Managing stress is essential in reducing the urge to pull hair, as stress is a common trigger for trichotillomania. Techniques like mindfulness, relaxation exercises, and time management can help individuals better cope with stress. The advantage of stress management is that it can improve overall mental health and reduce hair-pulling incidents. However, it may be challenging to learn stress management techniques without the help of professional medical experts.

Exercise

Regular exercise is beneficial for managing trichotillomania as it helps reduce stress and anxiety, the main triggers of hair-pulling behaviors. Physical activities like jogging, yoga, weight training, cardio, or team sports can help relieve tension and improve overall well-being. However, you need to have the proper time and motivation to maintain a regular exercise routine.

Deep Breathing

Deep breathing exercises can help manage the constant urge to pull hair by providing relaxation and reducing anxiety. Techniques like diaphragmatic breathing or the 4-7-8 method can be practiced anywhere and anytime. However, deep breathing may not be sufficient as a standalone treatment for more severe cases of trichotillomania.

Mantra

Using a mantra involves repeating a calming word or phrase to yourself to divert attention from the urge to pull hair and reduce stress. You can use this technique during moments of intense craving or anxiety. The advantage of using a mantra is its ease of use and the ability to provide quick mental relief. However, you may need to combine mantra with other treatment strategies for better results, like exercising, deep breathing, or medications.

Medication

Medications like serotonin reuptake inhibitors (SSRIs), can be helpful to help manage trichotillomania, particularly if it happens due to depression or anxiety. Medications can help reduce the urge to pull hair by addressing underlying chemical imbalances in the brain. However, medications come with possible side effects and the need for monitoring by a healthcare provider.

What Medications Are Used to Treat Trichotillomania?

Trichotillomania requires a combination of different medications to target different aspects of the disorder. For example, serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are prescribed to help reduce anxiety and depression. Low doses of antipsychotic medications like olanzapine are prescribed if the trichotillomania is severe with psychotic symptoms.

Some healthcare professionals may prescribe anticonvulsants like topiramate. These drugs are used to treat epilepsy but can also help with impulse control disorders. Similarly, individuals can get N-acetylcysteine (NAC), an amino acid supplement. It works by controlling glutamate levels in the brain, which can help control compulsive behaviors.

These medications can be beneficial, but they may carry risks like potential drug addiction. Therefore, they should be prescribed and monitored by a healthcare professional.

Is Trichotillomania a Type of Self-Harm?

No, trichotillomania is not classified as a form of self-harm. While both conditions involve causing harm to yourself, they have slight differences too. Self-harm, like cutting or burning, is deliberate and used to cope with emotional distress. On the other hand, trichotillomania is an impulse control disorder where hair-pulling provides relief from tension or anxiety, often without the intention of causing harm.

Is Trichotillomania Contagious?

No, trichotillomania is not contagious. It is a mental health disorder characterized by compulsive hair-pulling. It is not caused by a virus or bacteria and cannot be transmitted from one person to another through physical contact. Trichotillomania develops due to a combination of genetic, biological, psychological, and environmental factors, making it a personal condition.

FAQs

How long does Trichotillomania last?

The duration of trichotillomania can vary. For some people, it may be a lifelong condition with periods of betterment and relapse. Others may experience quick recovery or find effective treatment early on. The course of trichotillomania is influenced by factors like stress levels, access to treatment, and individual coping mechanisms. Early treatment with therapy and support can often help manage symptoms and provide quick recovery.

Is Trichotillomania a disease?

No, trichotillomania is a mental health disorder, not a disease. The disorder is considered an impulse control disorder and is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Is Trichotillomania genetic?

Yes, trichotillomania has a genetic component, meaning it can run in families. Individuals with a family history of trichotillomania or other related disorders, like obsessive-compulsive disorder (OCD), may have a higher risk of developing the condition themselves. However, genetics alone do not determine whether someone will develop trichotillomania.

Is Trichotillomania a part of anxiety?

Trichotillomania is often associated with anxiety disorders, but it is not a direct part of anxiety. However, individuals can experience anxiety frequently with trichotillomania.

Is Trichotillomania included in the DSM-5?

Yes, trichotillomania is included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). It is classified under the category of Obsessive-Compulsive and Related Disorders.

Is Trichotillomania a choice?

No, trichotillomania is not a choice. It is a mental health disorder where one has no control over their compulsive hair-pulling behaviors. Individuals with trichotillomania can’t stop despite repeated efforts. It is not a voluntary behavior or a conscious decision.