Trichotillomania, the compulsion to pull out hair

Basil Manning
Trichotillomania, the compulsion to pull out hair

Trichotillomania is a type of impulse control disorder. People with this disorder are aware that they are hurting themselves by acting in this way, letting themselves be carried away by impulses, but they still cannot stop. They tend to pull their hair out when stressed as a way of trying to calm down.

People with trichotillomania have an irresistible urge to compulsively pull their hair, usually from the scalp, eyelashes, and eyebrows, but it can be from different parts of the body. And it is not that it happens because the person in question does not know, does not feel or is not aware of the damage that can be done. It is. But despite this, he cannot restrain the need to carry out this practice. However, it is not something they do continuously, rather it is a mechanism to cope with pressure and stress, trying to calm down..

People with this type of problem know that they can hurt themselves by acting impulsively, but somehow they cannot stop. They tend to pull their hair out when they are anxious or stressed to try to calm down.

In psychiatry it is classified as an impulse control disorder, as is the case with kleptomania or pyromania.


  • Origin of the disorder
  • Symptoms of Trichotillomania
  • Causes of Trichotillomania
  • Associated disorders and comorbidity
  • Treatment of Trichotillomania
    • References

Origin of the disorder

It is a condition that appears around 13 years of age. It can happen before, but it is not usual. The most common is that it appears in early adolescence. The trigger is usually a stressful event, such as abuse, a family conflict, the death of someone close, a change in school or environment, etc. In short, a situation that the young person cannot fully understand and that stresses them.

There is no specific cause for this disorder to appear. Some researchers consider that it is possible that there is a neurochemical imbalance at the brain level (some type of serotonin deficit), but it is not confirmed. The most widespread opinion is that it is a combination of hormonal factors linked to a certain genetic predisposition, and that the triggering element is a traumatic circumstance.

That is, a person may have that genetic predisposition and the hormonal factors that could cause the disorder to appear, but, if the traumatic event does not appear, they will not develop it. In the same way, a person can suffer traumatic events, but, if they do not have this predisposition and those hormonal problems, trichotillomania will not appear..

However, as we say, the causes are not clear.

As for the people affected, we find that 1% of the population suffers from this problem, and that it occurs equally in men in women. Actually, according to the registered cases, it occurs a little more in women, but, it seems, this is because they seek treatment more frequently, which is why they appear more times in the registries.

Symptoms of Trichotillomania

In addition to compulsive hair pulling, there are other symptoms that you can suffer from:

  • Feeling anxious before pulling your hair or trying to resist temptation.
  • Feel relief or satisfaction after pulling.
  • Problems at work or social life due to the anxiety that this causes and the appearance they offer after pulling their hair.
  • Behaviors such as inspecting the hair root, twisting hair, pulling hair with teeth, or even eating hair.

Many people who have trichotillomania try to deny the problem and may try to hide their hair loss by wearing hats, scarves, false eyelashes, or eyebrows..

Causes of Trichotillomania

The exact cause of trichotillomania is not known. However, we do know that there are several factors to consider. Certain personality traits such as low stress tolerance, perfectionism, and a tendency to suffer from anxiety are evident. The way to process external stimuli is also relevant when talking about etiology. Although as in all other mental health disorders, there are always exceptions.

Neurobiological research using brain scans shows that the brain functioning of people with trichotillomania differs from healthy subjects, resembling those of people with attention deficit / hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). A genetic component has even been described in some cases, identifying families in which trichotillomania was diagnosed in parents and children or siblings.

Risk factors therefore include family history; age (the peak of onset is usually between 11 and 13 years of age); poor adaptation and emotional regulation mechanisms; premorbid mental health diagnoses such as ADHD, OCD, tic disorder, eating disorder, anxiety disorder, or depressive disorder.

Associated disorders and comorbidity

Trichotillomania is often accompanied by Obsessive Compulsive Disorder, such as the irrepressible need to count or wash your hands. In fact, many experts consider trichotillomania to be a type of OCD, given the degree of similarity between the two disorders..

It is also common for some type of depressive disorder to appear, which is why many experts have pointed out that there may be a relationship between the neurotransmitters involved in depression and trichotillomania. Both disorders (and also OCD) are linked to low serotonin.

However, not all experts agree on this last reasoning. Many of them do not consider that there is the same cause for both problems, but that the cause of depression and low levels of self-esteem is precisely trichotillomania and the day-to-day complications that it generates.

As you can see, trichotillomania is closely related to post-traumatic stress disorder and is a type of clinical anxiety and depression that leads to hair pulling and is normally present in patients with obsessive-compulsive disorder. We hope this information has been useful to you and, if you have any questions, you can leave it in the comments!!

Treatment of Trichotillomania

The main treatment for trichotillomania is a type of behavior modification therapy called habit reversal training. Basically, this means replacing a bad habit with something else that is not harmful..

With this approach, people with trichotillomania first learn to identify when and where they have the urge to pull their hair. They also learn to relax and do something else, that doesn't hurt, as a way to help relieve tension when they feel the need to pull their hair..

It could be as simple as clenching a fist with the hand that they would use to pull the hair out. Therapy can also address any distorted thinking that may be increasing the stress that triggers the behavior..

When trichotillomania manifests in adulthood, it may be associated with other psychological or psychiatric disorders, and consultation with a specialist is recommended, since hair pulling usually resolves when other conditions are treated.

Recognizing behavior and increasing awareness of the thoughts and feelings that drive impulses, as well as understanding that impulses are distinct from behaviors, helps to break the habitual cycle of pulling hair, increasing positive coping skills, and incorporating sensory self-regulation methods.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Editors of 4th ed. Washington DC: American Psychiatric Association; 1994

Damodaran SS, Jayalekshmi KT, Khanna R. Trichotillomania: symptom or syndrome. Need for revision? Psychopathology. nineteen ninety five

Christenson GA, Mansueto CS. Trichotillomania: descriptive characteristics and phenomenology. In: Stein DJ, Christenson GA, Hollander E, editors. Trichotillomania. Washington DC: American Psychiatric Press; 1999

Chamberlain, SR, Menzies, L., Sahakian, BJ, and Fineberg, NA (2007). Lifting the veil on trichotillomania. The American Journal Of Psychiatry, 164 (4), 568-574. doi: 10.1176 / appi.ajp.164.4.568

Stein DJ, Hollander E, Cohen L, Simeon D, Aronowitz B. Serotonergic receptivity in trichotillomania: neuroendrocrine effects of m-chlorophenylpiperazine. Biol Psychiatry. 1995

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