Trichotillomania: Symptoms, Causes, Treatments

The trichotillomania e s a disorder that causes patients in an irrepressible urge to jump and hair pulling. It is more common in women and children between three and seven years.

Trichotillomania Treatment

Although its causes are not clearly understood, it is known that those suffering from trichotillomania feel a great internal tension that causes them to pull their hair and twist it with great force, causing it to weaken and fall.

Trichotillomania, symptoms, causes

In many cases the symptoms begin in childhood or adolescence, before the age of 17 years. The hair is lost in the form of patches scattered all over the scalp, causing an uneven appearance.

Some people also rip their hair out of other areas, such as eyebrows, eyelashes and body hair.

The symptoms of trichotillomania include the following:

  • Unequal appearance in hair.

Pulling the hair and pulling it out can lead to small areas of thinning hair.

  • Scraggy areas or patches on the scalp.

This is especially seen in children, who are less ashamed of others discovering their habit. Some adults, in order to hide their problem, pull their hair in less visible areas.

  • The patient pulls or twists strands of hair all the time.
  • Deny the fact that the hair is torn.
  • You feel stressed or stressed before pulling your hair.
  • Feel relief, pleasure or gratification after pulling it.
  • It has other behaviors of self-aggression.

Many people with this disorder also have depression, anxiety and low self-esteem.

Those who suffer from trichotillomania get caught in thoughts that strain them and pull their hair because this relieves their stress momentarily. Pulling your hair is the only way they find to relieve their internal tension.

After a strand of hair has been plucked, some patients play with their hair making balls; others break them into pieces, make piles or directly take the hair to the mouth and swallow it (tricofagia).

You have to know that if there is trichophagia, the patient may have serious problems in his digestive tract, including intestinal obstruction, because the hair is not digested and can get trapped in different areas of the stomach or intestine.

As for the sensations perceived by people suffering from trichotillomania, these may vary.

Some people say they are fully aware when they pull their hair; they are really focused and paying attention to what they do, while others only realize that they have ripped off hair when they already have the lock in their hand.

On the other hand, some patients state that they have feelings of itching, tingling or pain, which are the ones that drive them to pull out of their hair. Instead others say they do not feel anything special, but simply have that urge to bring their fingers to the hair to pull it.

Causes of Trichotillomania

As we told you above, the causes of trichotillomania are not very clear.

However, some experts in psychiatry believe that this disease may be related to obsessive compulsive disorder, as patients experience an almost obsessive need to pull their hair.

It is an irrational and irresistible impulse, which causes anguish.

Trichotillomania is often associated with other obsessive symptoms and anxiety pictures.

On the other hand, the causes of this disorder may also influence genetic factors, temperamental (patients with difficulty regulating their behaviors) or triggers, such as stress.

Sedentary activities, such as watching television, reading a book or talking on the phone, may favor the emergence of this impulse. However, other people say that they pull their hair while they are doing other types of activities, like walking or doing gymnastics for example.

In general, people with trichotillomania do not try to harm themselves. It could be said that it is a habit similar to that of nail biting, only that it affects much more to the appearance of the person, who often is ashamed of its behavior and cannot control it.

Disorders that are characterized by self-inflicted injuries, such as cutting or striking the head, have treatments other than those routinely advised for trichotillomania.

However, it is always important to know the patient’s complete history before making any diagnosis.


While in some cases the urge to twist and pull hair can happen casually and lead to a transient disorder, in most cases it is established chronically, unless a treatment is followed.

One of the main consequences is that the hair weakens and changes its appearance, and instead of being whole and bright it looks as if it had been eaten by moths.

Also, as you have read in previous paragraphs, scabs or patches on the scalp may appear. It is also possible that the sparse area is diffuse rather than having a patch shape. The aesthetic consequences may be noticeable.

On the other hand, patients are ashamed of their behavior, which they cannot control, and so they try to hide it by fleeing from people.

In this way, trichotillomania can also have important social consequences (people suffering from it can develop social phobia).


If you have symptoms of this disorder or know someone who has them, it is best to see the doctor.

The professional will examine the skin, hair, and scalp. If patches or sparse areas are present, a sample may be taken for microbiological studies or biopsy to rule out other possible causes for hair loss, such as infections.

What sometimes makes diagnosis difficult is that people often deny or conceal a problem.

Therefore, they refuse to make a medical appointment or are forced by their relatives, downplaying the symptoms.

On the other hand, when trichotillomania is associated with other more serious disorders such as depression or obsessive compulsive disorder, physicians generally focus on solving major problems first and sometimes consider trichotillomania as a symptom of the main disease.

The detection of this condition can be relatively simple, simply by observing the disappearance of the hair and asking some simple questions to the patient or his relatives.

However, sometimes their diagnosis and treatment are hidden or delayed due to other more serious problems.

However, before making the diagnosis of trichotillomania, other possible causes for weakness and hair loss, such as fungal or bacterial infections, hormonal problems, nutritional deficiencies, etc. should be ruled out.

Possible treatments

There is also no consensus on the best treatment for trichotillomania. But do not worry, this problem can be addressed in different ways and it is possible to get good results.

As this is a mainly psychological disorder, most possible treatments are based on this aspect, although there are also some medications that can help.

The idea is not to focus on a single possibility but to combine different treatments to ensure a favorable evolution.

The main treatments for trichotillomania are the following:

Cognitive Behavioral Therapy

In cognitive behavioral therapy the patient is trained so that he can identify the moments in which he feels the impulse to pull his hair and to be able to establish new behaviors that prevent the execution of the mania.

For example, if a person pulls their hair while watching TV, a good idea may be to hold the remote control or some other object with both hands to control the impulse.

In addition, it can be used to explore the psychological bases of the disorder, while at the same time trying to strengthen the person’s self-knowledge and skills to control their behavior.

Psychotherapy can also be geared toward controlling the anxiety or stress that results in the pull of hair pulling.

Clinical hypnosis

It is a treatment that can be applied to treat different compulsive behaviors, such as smoking.

Although there is no research demonstrating its efficacy in this condition, it may also be useful in trichotillomania.

During the hypnosis session instructions are given to the patient so he can apply them the moment he feels the need to pull his hair.

The number of sessions each individual needs depends on the characteristics of the patient and the evolution of the disease.


While researchers do not agree on the best medicine for these cases, often antidepressants or drugs that control anxiety can help.

The naltrexone and selective inhibitors of serotonin reuptake have proved effective in reducing some symptoms.

How to prevent it

Early detection is the best way to prevent the disease, because it can be prevented from progressing if timely treatment is carried out.

Techniques that help control anxiety and stress can also be useful.

More tips

If you really want to start up all the weapons to avoid the urge to twist or pull hair, please look at the following tips.

  • It is convenient to have the hair always clean, because apparently the tendency to pull it increases if it is dirty. It may also be a good idea to use a strengthening shampoo.
  • Exercising to release stress and use relaxation techniques such as yoga or meditation can also be helpful.
  • The visit to the dermatologist is always advisable, as this will determine if there is any other reason for hair loss.
  • Try to detect the triggering situations. At what moment does the impulse arise? Is there a stress factor that triggers it?

If you think you suffer from trichotillomania, then it may be a good idea to keep a diary.

In it you will note what happens to you in the day, the time when you have noticed that you have taken off hair, what you were doing at the time, etc. In this way you may be able to discover the factors that drive the momentum.

When you have done so, try to avoid these factors or distract yourself with other activities to avoid tearing more hair.

If the impulse to pull your hair is often impossible to control, it is best to seek professional help.

What you can do to help people who suffer from it

If you have a family member or friend who suffers from this disorder, the first thing you can do is inform yourself well on the subject.

Sometimes it happens that although family and friends have really good intentions, they do not know how to help, especially when the affected person does not recognize that there is a problem.

In these cases, it is best to speak directly about what concerns you, without intending to convince you of anything.

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Simply tell him that you are worried because you love him and that you think it would be a good idea to consult a professional.

Effective communication, calm and calm, flexibility and patience are essential in these cases.

And if the affected is your child, of course, do not hesitate to take him to the pediatrician’s office at the first symptoms.

If you feel identified with some of these symptoms or know someone who has them, seeking professional help is the best you can do.