Trichotillomania (Hair Pulling)

Trichotillomania, commonly referred to simply as TTM, is a condition characterized by mild to severe compulsive hair pulling from anywhere on the body. It is an impulse-control disorder and one of several body-focused repetitive behaviors (BFRBs) currently classified in the DSM-5 as Obsessive Compulsive and Related Disorders. TTM affects up to 2 percent of the population, and only about half of those affected receive some form of treatment. 

Symptoms

Symptoms of TTM typically first appear between the ages of 10 to 13. The primary symptom is an urge to pull hair from the scalp, eyebrows, eyelashes, pubic or other area of the body. The behavior is compulsive and results in significant hair loss that can lead to alopecia, or bald spots on the scalp.

According to the DSM-5, individuals with TTM may also:

  • Experience feelings of distress, shameanxiety, and embarrassment about their condition
  • Avoid developing close relationships
  • Refrain from attending group activities
  • Use scarves, wigs, alternative hairstyles, or makeup to cover up areas of the body with noticeable hair loss

TTM can lead to infection and cause physical damage to skin tissue, joints, and muscles, especially if scissors or other sharp objects are used to help facilitate hair pulling. In rare cases, people with TTM develop medical complications from eating their pulled hairs, which can result in the development of hairballs that obstruct the intestines. Co-existing psychological problems such as eating, mood, and personality disorders are common.

Causes

There may be a genetic link to TTM, since some people appear to have an inherited tendency to pull hair as well as a higher-than-average number of first-degree relatives with mood and anxiety disorders. TTM may also be associated with perfectionism. It can be used as a means of avoiding stressful events or releasing the tension that builds up as a result of emotions such as impatience, frustration, dissatisfaction, and even boredom. TTM is not diagnosed when hair loss is due to substance abuse, a dermatological condition, or another physical or psychological problem.

Treatment

Shame and other negative feelings may prevent some people from seeking treatment specifically for TTM, and those who do not pursue treatment may have less severe symptoms and fewer negative feelings about the condition than those who do seek treatment. Research results indicate, however, that the severity and duration of hair pulling is similar for those who seek treatment and those who do not. People with TTM who experience more severe depressive symptoms may also be more inclined to seek help for depression, which in turn may lead to help with hair pulling. Cognitive behavioral therapy (CBT) with habit reversal training and progressive muscle relaxation can be effective for treating TTM. Acceptance and commitment therapy (ACT) and a self-help technique known as movement decoupling may also prove beneficial. Researchers have found that individuals who are reluctant to seek conventional treatment may benefit from Internet-based interventions. While no medications are approved as a first-line treatment for TTM, some antidepressants, antipsychotic medications, and cannabinoid agonists have shown promise in limited studies.

References

  • American Psychiatric Association, Diagnostic and Statistical Manual, Fifth Edition
  • Grant JE, Chamberlain SR. Trichotillomania. Treatment in Psychiatry. September 1, 2016;173(9):868-874.
  • The TLC Foundation for Body-Focused Repetitive Behaviors website. What Is Trichotillomania?
  • Weidt S, Bruehl AB, Delsignore A, et al. Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention. Neuropsychiatric Disease and Treatment. 2017;13:1153-1162.  Published online April 21, 2017.
  • National Institutes of Health 

Last reviewed 01/19/2018