Trichotillomania
Definition
Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. People are unable to stop this behavior, even as their hair becomes thinner.
Alternative Names
Trichotillosis; Compulsive hair pulling
Causes
Trichotillomania is a type of impulsive control disorder. Its causes are not clearly understood.
It may affect as much as 4% of the population. Women are 4 times more likely to be affected than men.
Symptoms
Symptoms most often begin before age 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.
These symptoms are most often seen in children:
- An uneven appearance to the hair
- Bare patches or all around (diffuse) loss of hair
- Bowel blockage (obstruction) if people eat the hair they pull out
- Constant tugging, pulling, or twisting of hair
- Denying the hair pulling
- Hair regrowth that feels like stubble in the bare spots
- Increasing sense of tension before the hair pulling
- Other self-injury behaviors
- Sense of relief, pleasure, or gratification after the hair pulling
Most people with this disorder also have problems with:
- Feeling sad or depressed
- Anxiety
- Poor self-image
Exams and Tests
Your health care provider will examine your skin, hair, and scalp. A piece of tissue may be removed (biopsy) to find other causes, such as a scalp infection, and to explain the hair loss.
Treatment
Experts don't agree on the use of medicine for treatment. However, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in reducing some symptoms. Behavioral therapy and habit reversal may also be effective.
Outlook (Prognosis)
Trichotillomania that begins in younger children (less than 6 years old) may go away without treatment. For most people, the hair pulling ends within 12 months.
For others, trichotillomania is a lifelong disorder. However, treatment often improves the hair pulling and the feelings of depression, anxiety, or poor self-image.
Possible Complications
People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.
Prevention
Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.
References
American Psychiatric Association website. Obsessive-compulsive and related disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:235-264.
Ken KM, Martin KL. Disorders of hair. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 682.
Weissman AR, Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 23.
Review Date:4/30/2022
Reviewed By:Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.
Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.
Health Outcome Data
No data available for this condition/procedure.
