For many, there is something natural about feeling like you want to pull all of your hair out when you’re stressed or overwhelmed. But for millions of others, this is more than a feeling – it is a reality.The condition, known as “trichotillomania,” effects as much as 4% of the population at some point in their life (roughly 280,000,000 people in the world), and is a common and frequent symptom of stress and anxiety. It’s also not well known, and many people struggle with the condition in silence.

What is Trichotillomania?
Trichotillomania also called hair-pulling disorder is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. In simple words it is compulsive pulling out of one’s own hair to the point that it is noticeable and causing significant distress or impairment.

The act being preceded by tension or an irresistible urge and followed by pleasure or relief. The diagnosis excludes such activities when caused by physical factors or by delusions or hallucinations. Specific patterns or rituals of hair pulling are often present.

It begins in childhood, and is more common in girls female: male ratio is 8:1 in pre-adolescents and 3:1 in adults—peaking at age 12–13; it is a disorder of impulse control, linked to tics, and habit disorders—e.g., thumb-sucking

What are the symptoms of Trichotillomania?
Signs and symptoms of trichotillomania often include:

  • 1. Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time
  • 2. An increasing sense of tension before pulling, or when you try to resist pulling
  • 3. A sense of pleasure or relief after the hair is pulled
  • 4. Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
  • 5. Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
  • 6. Biting, chewing or eating pulled-out hair
  • 7. Playing with pulled-out hair or rubbing it across your lips or face
  • 8. Repeatedly trying to stop pulling out your hair or trying to do it less often without success
  • 9. Significant distress or problems at work, school or in social situations related to pulling out your hair

Trichotillomania Causes – Why Do People Pull Their Hair?
There is evidence that trichotillomania can run in families, meaning that somehow there is a genetic cause. But not everyone with parents that pulled their hair is going to develop the condition. Usually, the development of trichotillomania is brought on by one of the following:

  • 1. Anxiety and Stress
    The most common and most frequent cause of trichotillomania is anxiety and stress. The impulse to pull hair appears to be stronger when someone has anxiety and stress. There is evidence that it has a calming effect on the nerves.
  • 2. OCD Compulsions
    Although obsessive compulsive disorder is an anxiety disorder, it deserves its own place as a cause of hair pulling. Obsessive compulsive disorder occurs when someone’s obsessions (chronic thoughts) lead them to developing habits to help them stop those thoughts, known as “compulsions.
  • 3. Self-Harm
    There are some that believe that trichotillomania is a form of self-harm, much like cutting disorders and self-mutilation. This may be true in select cases, but it is likely rare that this is the problem. Although hair pulling can cause momentary instances of pain (which, as in the case of self-harm disorders, some people perform “just so they can feel the rush”), the pain is usually not very pronounced and the link between the two is weak at best. It is possible that some people pull their hair as a form of self-harm, but most instances are going to be related to stress.
  • 4. Dysregulation of neurotransmitters serotonin and dopamine.
    It is believed that some dysregulation in neurotransmitters is present in person with trichotillomania
  • 5. Genetic influence
    Two mutations in genetic marker SLITRK1 have been implicated

Although it may not seem particularly serious, trichotillomania can have a major negative impact on your life. Complications may include:

  1. • Emotional distress. Many people with trichotillomania report feeling shame, humiliation and embarrassment. They may experience low self-esteem, depression, anxiety, and alcohol or street drug use because of their condition.
  2. • Problems with social and work functioning. Embarrassment because of hair loss may lead to avoid social activities and job opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
  3. • Skin and hair damage. Constant hair pulling can cause scarring and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled and can permanently affect hair growth.
  4. • Hairballs. Eating hair may lead to a large, matted hairball (trichobezoar) in your digestive tract. Over a period of years, the hairball can cause weight loss, vomiting, intestinal obstruction and even death.


  1. • Psychotherapeutic: Trichotillomania is treated primarily through behavioral therapy. Cognitive behavioral therapy (CBT), which helps children become more aware of their hair pulling, is very helpful. Through CBT children can come to recognize the emotions and triggers involved in their hair pulling. Sometimes something as simple as wearing loud, dangling bracelets can make kids more self-aware.
    After learning to recognize the habit, children can then begin habit reversal therapy. Some doctors recommend tricks that make hair pulling more difficult. For example, wearing bandages around the fingers and nails can make it harder to pull out hair, as does wearing hair pulled back or under a hat. For kids who enjoy the sensation of playing with the hair after it has been pulled, rolling a paper clip or playing with a textured pencil topper can help recreate the desired sensation and keep the hands distracted. Some kids in treatment carry kits around with bandages, paper clips, hair ties and other items that will help them.
  2. • Pharmacological: Medication is usually not the first choice in treating trichotillomania, although children may be prescribed antidepressants like SSRI’s while they participate in behavioral therapy.


By – Tutor – Mrs Deepika
Department of Nursing
Uttaranchal (P.G.) College Of Bio-Medical Sciences & Hospital

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