Trichotillomania: Hair-Pulling and Beyond

Despite affecting 2% of the world’s population, Trichotillomania doesn’t often come up in conversation.

Disorders such as Schizophrenia and OCD are featured heavily in the news despite their prevalence being lower, with Schizophrenia affecting around 0.32% and OCD affecting between 1-3% globally.

In this article, we’re going to discuss what Trichotillomania is, the symptoms, the causes and the treatment available.

What is Trichotillomania?

Trichotillomania, also known as trich or TTM, is when someone feels compelled to pull their hair out. It sits under the umbrella of Body-Focused Repetitive Behaviours (BFRBs) and is listed under ‘Obsessive-Compulsive Disorder and Related Disorders in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM).

A person might want to pull out the hair on their head or from other areas of the body, such as the eyebrows or eyelashes.

Trichotillomania usually begins between the ages of ten and thirteen years old.

Symptoms of Trichotillomania

A person suffering from Trichotillomania will likely feel an intense urge to pull one’s hair out, and they will feel tense until they can. They will feel relieved once they have pulled the hair out.

If a person with Trichotillomania is under stress, they will likely respond by pulling their hair out or it could be done without them even thinking about it.

The majority of people with Trichotillomania focus on pulling hair from their head, but they may also pull hair from the following areas:

Their eyebrows
Their eyelashes
The genital area
Their beard or moustache

Trichotillomania can cause low self-esteem and shame to the person dealing with it so they may try to hide it.

Causes of Trichotillomania

There isn’t a solid cause known but the following genetic and learned factors are likely to have an impact:

It could be your specific way of dealing with stress or anxiety
A chemical imbalance in the brain
Changes in your hormone levels during puberty
Genetic factors, such as a family member having the same issues
It can be a habit formed that is hard to break
It can also be environmental, due to isolation or boredom

Treatment available

Trichotillomania is often treated using a branch of CBT called habit reversal training. This type of CBT helps a person replace their negative habits with something that isn’t harmful.

The treatment will usually involve:

Keeping a diary to track the hair-pulling
Working towards finding out the triggers, and learning to avoid them
Working toward replacing the hair-pulling with another habit, such as squeezing a stress ball
Learning how to reach out to loved ones for support

Medication isn’t usually prescribed to treat Trichotillomania.

There are also some things that a person can try before committing to CBT:

Learn to keep your hands busy – this can be using a fidget toy or stress ball
Keep your hair length short – this will give you less hair to work with
Try to resist hair-pulling for as long as possible – if you do this for longer each time, you’ll eventually be able to stop
Get rid of tweezers – remove the temptation