Trichotillomania: Information, Symptoms, Treatment and More

Trichotillomania is a mental health condition which involves an individual having the irresistible urge to pull out their own hair. Trichotillomania is also known as Trich, and is a very difficult condition to live with.

This condition is closely tied to Obsessive-Compulsive Disorder. It is an Obsessive-Compulsive Spectrum disorder.

Someone with Trichotillomania will feel an intense and overwhelming urge to pull out their hair, and will experience ongoing tension until they perform the act. Relief is only temporary, leading to a vicious cycle occurring.

What are the symptoms of Trichotillomania?

An individual with Trichotillomania will have obsessions and compulsions:

Obsessions: An obsession is an unwanted and unpleasant thought, doubt, image or urge that repeatedly enters a person’s mind. As a result, the person experiences anxiety or general unease. Examples include fear of contamination, and a need to organise items symmetrically.

Compulsions: A compulsion is a repetitive action that the person then carries out to temporarily relieve the anxiety brought on by the obsession. Examples include rituals, checking and reassurance.

In the case of Trichotillomania, the patient will feel an intense and overwhelming urge to pull out their hair. Until they go through with the act, tension will grow.

Once hair has been pulled out, the individual will feel a sense of relief – though this is only temporary. As mentioned earlier, this becomes a very distressing cycle.

The cycle will normally begin with a stressful event or situation. As a result, the person may feel a compulsion to pull out their hair. The idea may be that the act of pulling out hair will relieve the stress, and help an individual calm down.

Sometimes the individual will just pull one hair out at a time. However, the hair pulling can last for several minutes. Hair can be pulled from any area, though the scalp is the most common area. Other areas include eyebrows, eyelashes, facial hair, arms, legs or hair around the genitals.

Trichotillomania can then lead to low self-esteem and/or fears of socialising, due to the abnormal appearance that may develop as a result of hair-pulling.

What are the causes of Trichotillomania?

It isn’t entirely known that causes Trichotillomania. However, some factors do appear to be involved with the condition developing. Often, a range of factors contribute to the onset of Trichotillomania.

The way an individual deals with stress is key. Everyone has different ways to react and deal with stress and anxiety. Simply put, for some people, pulling out hair is the response. While this may just happen once or twice, it can easily become a habit that becomes Trichotillomania.

Most cases of Trichotillomania take place around the same time as puberty – which coincides with changes in hormones. This would suggest hormonal changes can alter an individual’s behaviours.

Trichotillomania is also a form of self-harm. While self-harm has many potential causes, it is often a way to appease feelings of emotional distress.

Pulling out hair can become an addictive behaviour. Some people may like the initial feeling, leading them to want to repeat the feeling to get the initial ‘high’ again.

It may also arise out of another mental health condition which involves self-harm – such as Depression, Anxiety or trauma-based disorders. As with all mental health conditions, any traumatic event could feasibly cause Trichotillomania.

Additionally, research suggests that there may be a genetic component – with Obsessive-Compulsive Spectrum disorders like Trichotillomania commonly running in families [1].

Diagnosis of Trichotillomania

It is important for an individual to see a Doctor or mental health professional if they are suffering from Trichotillomania. It is sometimes down to a parent or close friend to try and seek the person to help.

They may notice hair missing or an irregular pattern in their hair, or suspect something is affecting them. It is normally clear when an individual has Trichotillomania. Areas of abnormal hair growth, differing lengths, missing areas of hair or scaling on the scalp can all be signs of Trichotillomania.

Seeing a doctor is important. At an appointment, a doctor will have a detailed conversation with the patient and ask several questions. They will ask questions about the severity of symptoms, potential causes, and the impact that the symptoms have on their daily life.

If a patient denies pulling out their hair, a doctor can evaluate other causes. A hair pull test is a useful way of assisting diagnosis, with the test being negative if Trichotillomania is present. Hopefully though the patient will admit to the hair pulling, and realise it is a behaviour that needs treatment.

In terms of the diagnostic criteria for Trichotillomania, the following should be met:

• Patient has the urge to pull out their hair
• The individual then carries out this urge
• If this doesn’t happen, the individual experiences emotional distress
• The individual will have attempted to ignore this urge
• The symptoms cause disruption in the day-to-day life of an individual
• The symptoms cannot be attributed to substance abuse
• The symptoms aren’t better explained by a different mental health condition

How is Trichotillomania treated?

Treatment is available for Trichotillomania, with the aim being full recovery and improved mental wellbeing. Treatment generally involves self-help and talking therapy.

Self help

Many people find using a stress ball or other object is a good substitute for hair-pulling. Wearing a hat or beanie could also help. These substitutions can be helpful.

When there is an urge to pull hair, deep breathing can help. A final idea is to put plasters on the fingertips to make it harder to pull out hair.

General self-help exercises like regular exercise, sleeping well and maintaining a good diet are all other ways of assisting your overall wellbeing.

Talking Therapy

Trichotillomania is normally treated by Cognitive Behavioural Therapy. A specific type of CBT called Habit Reversal Training is used. This form of CBT involves an individual working out the triggers for their actions, involving family to ensure support, and eventually replace the action of hair pulling with another action that isn’t harmful. 

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

There are a range of other types of talking therapies available if needed. For further information on therapy, you can see our dedicated Therapy section.

Medication

It is rather rare for medication to be used in the treatment for Trichotillomania. When it is, it is often due to co-occurring mental health problems, such as low mood or anxiety.

The antidepressant Clomipramine (Anafranil) is usually the medicine of choice, as it has proven effective in past trials for Trichotillomania [2]. Clomipramine is a Tricyclic antidepressant.

However, many have questioned the risk to benefit ratio of taking an antidepressant for Trichotillomania. SSRI antidepressants may also be prescribed.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Trichotillomania is a difficult condition to live with. It can be difficult to have the urge to pull out hair and the act of doing so typically causes an individual to have concerns about their appearance.

Accessing treatment is very important, and in the long run can help an individual see a substantial improvement in their condition, and hopefully in their quality of life too. For more information, feel free to navigate around our website.

See Also

• Obsessive-Compulsive Spectrum Section
• What is the Prognosis for Obsessive-Compulsive Spectrum Disorders?
• Therapy Homepage
• Medicine Homepage