Trichotillomania – Symptoms Causes Treatment

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Trichotillomania is a disorder that affects the skin cells on the scalp, eyebrows, or eyelashes. When trichotillomania occurs, people feel an irresistible urge to pull out their hair. Hair pulling episodes are typically brief, lasting for less than one hour. Some people may feel frustrated about trichotillomania and become upset when they notice bald spots or thinning hair.

People with trichotillomania often pull out hair from the scalp and their eyebrows (which is known as TTM). Others with trichotillomania pull out eyelashes. At times, trichotillomania can also involve pulling out body hair such as chest or leg hair (trichophagia), but this form of trichotillomania is rare. Trichotillomania can occur at any time during a person’s life; it has been reported in children as young as two years old. Trichotillomania often starts during the ages of six to twelve, affecting girls slightly more than boys.

People who have trichotillomania have an irresistible urge to pull out their hair, but do not experience pleasure or gratification from doing so. Pulling hair does not induce relaxation or relief from tension. People with trichotillomania may be aware that they are pulling their hair, but are unable to resist the urge. Sometimes trichotillomania is triggered by environmental factors such as stress or fatigue, though these triggers vary among people. At other times trichotillomania seems to occur without any obvious trigger at all.

When trichotillomania occurs, people may pull hair from the scalp or other parts of the body. They typically reach for hairs one at a time and pull them in an up-and-down motion with their fingers. Some trichotillomania sufferers twist, rub or shred the pulled-out hair (also trichotillophagia). People with trichotillomania can experience both short periods of intense urges to pull followed by good days when they can resist pulling; however, it is also possible that trichotillomania gradually gets worse over time.


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Trichotillomania has no known cause even though researchers believe it can develop due to various reasons including stress accumulation due to bullying or family problems, and that trichotillomania can be triggered by excessive stress. Studies also suggest trichotillomania may be linked to the neurotransmitter serotonin. Serotonin is a chemical found in the brain and it helps regulate moods and emotions; trichotillomania sufferers tend to have less serotonin than people without trichotillomania.

Trichotillomania is believed to be one of the most common body-focused repetitive behaviors (BFRBs), yet the disorder remains largely misunderstood and often underdiagnosed. The diagnosis of trichotillomania is usually delayed for years, impacting both adults and children alike. Some people with trichotillomania spend hours grooming their hair to hide bald spots or patches. Many trichotillomania sufferers feel embarrassed by the disorder and are reluctant to seek help.

Although trichotillomania most commonly occurs in adults, it can sometimes manifest itself with children aged six years old and up. Trichotillomania is thought to affect about two percent of both men and women. The condition tends to be more common among people who have family members with trichotillomania than those who do not; trichotillomania affects about 7% of first-degree relatives (parents, siblings, children) of trichotillomania sufferers as well as 10% of second-degree relatives (aunts, uncles, grandparents, cousins).

People with trichotillomania often avoid social situations involving appearance. They may also find it difficult to maintain healthy relationships because trichotillomania can cause them to be distant and preoccupied. With trichotillomania, the person pulls out their hair without being able to stop themselves even if they are making bald spots or thinning hair. The urge feels irresistible even though people know that pulling out the hair makes the problem worse. People with trichotillomania realize that it is not just a bad habit as they would do something differently if they could control it better, so trichotillomania is classified as an impulse control disorder or obsessive-compulsive spectrum disorder (OCD).

Effects on Human Body

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Trichotillomania is a chronic disorder that typically begins in childhood or adolescence and may continue throughout life. While trichotillomania often occurs in people with depression, anxiety, stress, or other mental health conditions, many trichotillomania sufferers have no co-existing mental health conditions. It is possible trichotillomania can trichotillomania may affect people differently in terms of how much pulling occurs, the impact on daily life, and how long trichotillomania lasts.

Trichotillomania is typically chronic although it tends to go through periods when the person pulls less often or not at all. People with trichotillomania may be able to control trichotillomania during times of stress or illness, but once the initial event passes trichotillomania may return.

Diagnosis is usually based on the person’s history, including their medical and psychiatric health as well as trichotillomania severity, frequency, and duration. Trichotillomania can be difficult to diagnose because trichotillomania habits can be hard to detect or hidden. Trichotillomania is not always easy to spot, trichotillomania may be disguised as a simple habit, such as nail-biting or face touching. Sometimes trichotillomania has no observable symptoms at all.

If trichotillomania is noted, trichotillomania may be diagnosed as an impulse control disorder or an OCD spectrum disorder.

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