Trichotillomania: The Strange Obsession Of Pulling Out Hair

A fairly common mania among anxious people.

The  Trichotillomania  is a rare disorder characterized by  the irresistible urge to flopping hair, usually from the scalp, eyebrows and eyelashes.

Despite the fact that individuals suffering from this pathology are aware of the damage that can be done by acting in this way, they are unable to stop or control this impulse. In addition, it is common that in times of stress these individuals try to pull out their hair as a way to calm themselves down, so a vicious circle occurs that can cause greater damage, both physically and psychologically.

What is Trichotillomania?

This condition usually appears around the age of 13 and is officially classified as an impulse control disorder, the same as pyromania, kleptomania or pathological gambling. It is also closely linked with Obsessive-Compulsive Disorder, since they share a large part of the symptoms and psychological mechanisms out of adjustment.

It has a prevalence of 1% of the population and affects men as well as women, although the latter more frequently seek treatment.


Trichotillomania is characterized by the presence of the following symptoms :

  • Recurring hair pulling causing a noticeable loss of it (as can be seen in the photograph).
  • An increased perception of tension just before pulling or resisting hair pulling.
  • Pleasure, gratification or liberation when pulling the hair.
  • The disturbance is not explained by another mental disorder or medical condition.
  • The alteration causes significant discomfort or deterioration in social, occupational or other important areas of activity. For example, a loss of self-esteem as a result of partial alopecia caused by hair pulling.

Warning signs

The onset of this disorder occurs around the age of 13, although in some cases it can start earlier. Frequently, a stressful event can be associated with this pathology, for example, changing schools, abuse, family conflicts or the death of someone close to them can generate anxiety and nervousness and cause the debut of this disorder. 

Some experts claim that the symptoms can be caused, or at least strongly influenced, by the hormonal changes typical of puberty.

Most probable causes

The adolescence is a critical stage for the development of self – esteem, body image, self – confidence, or intimate relationships. During this period, people who suffer from this pathology can be ridiculed by their own family, friends or classmates. But, in addition, these people may feel great guilt or shame for not being able to stop this type of behavior. Even a small patch without hair can cause serious emotional problems for the person suffering from this condition.

In many cases, people who suffer from trichotillomania manage to lead a normal life: get married, have children … But in some cases, there are individuals who avoid intimate relationships for fear of exposing their disorder.

There is no specific cause for trichotillomania. Although some researchers think that it is possible that at the biological level there is a neurochemical imbalance at the brain level, mainly a serotonin deficit. There may also be a combination of factors such as genetic predisposition and an aggravating stress or circumstance. For example, a traumatic event.

Comorbidity (associated disorders)

It is common for people with trichotillomania to show symptoms of Obsessive Compulsive Disorder (OCD) such as counting or washing their hands. In fact, there are many similarities between trichotillomania and OCD, which is why some experts consider it a subtype of Obsessive Compulsive Disorder.

Depressive disorder also often occurs alongside trichotillomania. There may be a direct relationship between the neurotransmitters involved in depression and this condition (and also OCD), as both pathologies are associated with low levels of serotonin. Although there could also be a relationship between depression and low self-esteem caused by trichotillomania, because pulling your hair can be demoralizing. On the other hand, pulling hair can lead to wounds that cause physical and emotional pain.


Trichotillomania can be treated in two ways, according to research conducted in this field.

1. Psychotherapy

On the one hand, cognitive behavioral therapy is very effective. On the other hand, and in some serious cases, the administration of drugs is necessary. However, the ideal is the combination of both treatments.

With cognitive behavioral therapy,  patients learn to identify and manage symptoms and employ strategies that help improve their quality of life. You can learn more about this type of therapy in our article: ” Cognitive Behavioral Therapy: what is it and on what principles is it based? “

2. Pharmacology

Medication can also be effective in treating symptoms, although cognitive behavioral therapy is necessary for long-term results. Some medications (antidepressants or mood stabilizers) used to treat this pathology are:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Clomipramine (Anafranil)
  • Valproate (Depakote)
  • Lithium (Lithobid, Eskalith)

Bibliographic references:

  • Christenson GA, Crow SJ (1996). “The characterization and treatment of trichotillomania”. The Journal of clinical psychiatry. 57 Suppl 8: pp. 42-7; discussion. pp. 48 – 49.
  • Christenson GA, Mackenzie TB, Mitchell JE (1991). “Characteristics of 60 adult chronic hair pullers”. The American journal of psychiatry 148 (3): pp. 365-70.
  • Salaam K, Carr J, Grewal H, Sholevar E, Baron D. (2005). Untreated trichotillomania and trichophagia: surgical emergency in a teenage girl. Psychosomatics.
  • Woods DW, Wetterneck CT, Flessner CA (2006). “A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania”. Behavior research and therapy 44 (5): pp. 639-56.
  • Zuchner S, Cuccaro ML, Tran-Viet KN, et al. (2006). SLITRK1 mutations in trichotillomania. Mol. Psychiatry.

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