Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner.
Trichotillosis; Compulsive hair pulling
Causes, incidence, and risk factors
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 four times more likely to be affected than men.
Symptoms usually 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 usually 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
Poor self image
Signs 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.
Experts don't agree on the use of medication for treatment. However, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown effective in reducing some symptoms. Behavioral therapy and habit reversal may also be effective.
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.
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.
Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.
Morelli JG. Disorders of the hair. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 654.
Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 23.
Kratochvil CJ, Bloch MH. Trichotillomania across the life span. J Am Acad Child Adolesc Psychiatry. 2009;48:879-883.
Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.