Trichotillomania or hair-pulling disorder: Symptoms and causes of

You may think pulling your own hair is just a bad habit, but do you know it may actually be a disorder? People with hair-pulling disorder or trichotillomania have a strong urge to pull their hair out. They experience growing tension until they pull a few strands or a chunk of hair out, and feel a sense of relief after doing so. It may be in response to a stressful situation, or it may be done without giving it much thought. They not only pull out hair from their scalp, but also from other areas, such as their eyebrows and eyelashes. Read on to know everything about trichotillomania and ways to stop pulling your hair out.

What is hair-pulling disorder?

Hair-pulling disorder is also known as trichotillomania, which is a chronic disorder, says psychiatrist Dr Neatu Narang. It is characterised by repetitive pulling out one’s own hair, and most cases remain unrecognised until significant hair loss becomes visible. The lifetime prevalence of this disorder, which usually begins in the adolescence stage, is as high as 3.5 percent, according to a research published in StatPearls in 2023.

It is considered to be a variant of Obsessive Compulsive Disorder, in which a person has uncontrollable thoughts, and engages in repetitive behaviour. Increased tension before an act of hair pulling leads to the behaviour and then subsequent relief or satisfaction for brief periods, says the expert. There are two types of hair pulling:

• Focused pulling: In this, a person intentionally does it to control unpleasant personal experiences.
• Automatic pulling: It happens without the person being aware of it. It mostly happens during sedentary activities like just sitting.

Once you stop pulling out your hair, new hair growth may start. But it may take months or years for the hair to grow back.

What are the causes of trichotillomania?

It is not known what causes a person to develop the hair-pulling disorder, but some may do it to alleviate stress. A person who has a mother or father or sibling with this disorder has a higher chance of having this condition.

What are the symptoms of trichotillomania?

People with trichotillomania experience an irresistible urge to pull out their hair.

• They also experience an increasing sense of tension before engaging in this behaviour.
• They achieve a sense of tension release or gratification from pulling out their hair.
• Upon noticing significant hair loss, they make repeated attempts to decrease or stop hair pulling but they fail to do so.
• Skin irritation at affected areas
• Bald patches due to pulling own hair.

How is hair-pulling disorder diagnosed?

To diagnose trichotillomania, a doctor will check if there is visible hair loss. If there is hair loss, the doctor may talk about it, and your behaviour connected to it.

How to prevent trichotillomania?

The key to prevention of hair-pulling disorder is early detection of the individual’s poor stress tolerance and coping skills, says Dr Narang. Stress management and early intervention to handle emotional pain, go a long way to prevent hair-pulling disorder.

What are the ways to treat trichotillomania?

Hair-pulling disorder, like obsessive compulsive disorder, respond to anti-obsessional and anti-depressant medications, with regular follow-ups and supervision by a psychiatrist, says the expert.

There are no medicines approved by the US Food and Drug Administration specifically for its treatment, but habit reversal training can help. The aim of the treatment is to help you replace a bad habit with something that can not harm you, as per the UK’s National Health Service. It usually involves:

• Maintaining a diary of your habit of pulling your own hair
• Finding out the triggers for hair pulling
• Replacing it with another action, like squeezing a stress ball whenever there is an urge to pull hair
• Getting emotional support from loved ones.

Trichotillomania or hair-pulling disorder usually begins in the adolescent phase. Habit reversal training and support from loved ones can help people with trichotillomania.