Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), also referred to as “hair-pulling disorder,” is a mental disorder classified under Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling.
Hair pulling from the face can result in complete or partial removal of the eyebrows and eyelashes, while hair pulling from the scalp can result in varying degrees of patches of hair loss. The hair pulling and subsequent hair loss results in distress for the person, and can interfere with social and occupational functioning.
For some people, the symptoms of trichotillomania are manageable, but for others, the symptoms can be completely overwhelming.
Symptoms of Trichotillomania
The primary feature of trichotillomania is recurrent pulling of one’s own hair. Pulling Out Hair Disorder can occur in any region of the body in which hair grows; the most common sites include the scalp, eyebrows, and eyelids. Less common areas include facial, pubic, and peri-rectal regions.1
Other symptoms can include the following:
- Repeated attempts to decrease or stop hair pulling
- Hair pulling causes distress or impairment in social, occupational, or other areas of functioning
- An increasing feeling of tension before the hair pulling, or when trying to resist pulling
- A feeling of relief after pulling
- Noticeable hair loss
- Playing with pulled hair, or rubbing it across the face or skin
- Biting, chewing, or eating pulled hair
- Pulling certain kinds of hair (certain textures)
- Hair pulling often occurs in private
Emotional States
Hair pulling may be triggered by or accompanied by a number of emotional states. It can be preceded by anxiety, boredom, stress, or tension, and can result in feelings of gratification, relief, or pleasure following the pulling.2
Hair pulling can also involve varying degrees of awareness.
Focused hair pulling: Some people engage in focused hair pulling with the intention of experiencing tension relief from pulling. In this case, the hair pulling can include specific rituals, including pulling certain types of hair.
Automatic hair pulling: Some people engage in hair pulling without fully realizing it. This can occur when they are bored, watching TV, or engaged in other mindless activities.
Mixed hair pulling: Many people engage in a mix of both behavioral styles.
Many individuals diagnosed with trichotillomania also have other body-focused repetitive behaviors, including skin picking, nail biting, and lip chewing.
Prevalence
The 12-month prevalence for trichotillomania in adults and adolescents is 1-2%, with a female to male ratio of 10:1. Among children, females and males are more equally represented.
The onset of hair pulling most often coincides with or follows, the onset of puberty. The course of the disease is chronic, though individuals can experience symptoms that wax and wane over time.
There does appear to be a genetic component to trichotillomania. The disorder is more common among individuals with obsessive-compulsive skin picking disorder and their first-degree relatives than the general population.
