Trichotillomania, also known as TTM or hair-pulling disorder, is a rare mental health condition in which a person repeatedly pulls out their hair, leading to noticeable hair loss. This disorder is part of the obsessive-compulsive spectrum, which includes conditions characterized by persistent thoughts and repetitive behaviors that interfere with daily life.
An estimated 3–4% of the population experiences trichotillomania, with symptoms typically beginning before age 17—most often between ages 12 and 13. While some studies suggest that women are more commonly affected than men, this could be because women are more likely to seek professional help.
Due to the stigma surrounding the disorder, many individuals avoid social situations, suffer from low self-esteem, and delay seeking treatment. Fortunately, effective treatment can significantly reduce symptoms, often within three to six months.
Symptoms
The main symptom of trichotillomania is noticeable hair loss resulting from repetitive hair pulling. Affected individuals often target the scalp, eyebrows, or eyelashes, though any area of the body with hair may be involved. It is also common to pull hair from multiple locations, with episodes lasting from a few minutes to several hours. Hair loss on the scalp may appear as patchy or uneven.
Additional signs may include:
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Denial about pulling hair
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Short stubble in bald patches
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Scarring or permanent hair loss
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Emotional distress such as anxiety, depression, low self-worth
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In some cases, ingesting the pulled hair, which can lead to constipation
What Causes Trichotillomania?
The exact cause remains unknown, but research points to several possible contributors. Some individuals report that stress, boredom, or anxiety trigger hair-pulling behaviors. The act of pulling often brings a sense of relief or satisfaction, reinforcing the behavior over time. In other cases, people pull hair unconsciously, not realizing what they are doing.
Experts theorize that the condition may be a coping mechanism or a subconscious reaction to stress. Brain structure differences could also make some individuals more susceptible to trichotillomania.
Risk Factors
There is some evidence of a genetic link to trichotillomania, though findings are not conclusive. The disorder does not appear to be more prevalent based on gender, race, income, or education level. As such, there are no clearly defined demographic risk factors.
Diagnosis
Diagnosing trichotillomania involves a psychiatric evaluation and a physical exam. During the evaluation, a mental health provider assesses your behaviors and emotional state using clinical questionnaires.
To be diagnosed, all of the following must be true:
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Recurrent hair pulling that leads to hair loss
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Repeated attempts to stop or reduce hair pulling
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The behavior causes significant emotional distress or functional impairment
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Hair loss is not due to a medical condition such as alopecia
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The behavior is not better explained by another mental disorder
A physical examination may also be used to evaluate areas of hair loss, examine the abdomen for swallowed hair masses, and rule out other medical conditions using tools such as scalp imaging or a hair pull test.
Misdiagnosis is common. Trichotillomania may be mistaken for OCD, anxiety, or other psychiatric disorders.
Treatments for Trichotillomania
Treatment focuses on reducing hair-pulling behaviors and improving emotional well-being. A team-based approach involving dermatologists, psychiatrists, psychologists, and primary care physicians is often most effective.
In children under six, the condition sometimes resolves without formal treatment.
Behavioral therapy is the most effective approach for managing trichotillomania. Common therapeutic methods include:
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Cognitive behavioral therapy (CBT): Helps individuals change negative thought patterns
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Habit reversal training (HRT): Teaches people to replace hair-pulling with more constructive actions
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Acceptance and commitment therapy (ACT): Focuses on mindfulness and acceptance strategies
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Peer support groups: Connect individuals experiencing similar issues for encouragement and shared strategies
Involving supportive friends, family members, or school counselors in treatment can also be beneficial.
Medications may be used, although none are specifically approved by the FDA for trichotillomania. Medications commonly used include:
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Selective serotonin reuptake inhibitors (SSRIs)
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Antipsychotics
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Tricyclic antidepressants
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Lithium
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N-acetylcysteine (NAC)
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Naltrexone
Research into the effectiveness of medication is ongoing, and behavioral therapy generally remains more effective than pharmaceuticals.
How to Prevent Trichotillomania Episodes
Following your treatment plan is key to reducing the frequency and severity of episodes. Some individuals find that stress-reduction techniques like yoga, progressive muscle relaxation, or deep breathing can help.
Related Conditions
Adults with trichotillomania often have co-occurring mental health issues, including OCD, PTSD, depression, social anxiety, and ADHD. Children, on the other hand, are less likely to have related conditions.
Some individuals also engage in related behaviors such as nail-biting or skin-picking. Complications from hair pulling may include headaches, scalp injuries, and carpal tunnel syndrome.
Living With Trichotillomania
People living with trichotillomania often struggle with low self-esteem, shame, guilt, and anxiety. Due to the stigma, more than half never seek treatment. However, those who do can see significant improvements within a few months.
Emerging technologies, such as mobile apps and wearable devices, offer new tools to support recovery. Ongoing research continues to improve our understanding of the disorder and how best to treat it.