Trichotillomania: Symptoms, Causes, Complications & Treatment

Created by: Tua Saude editing team

Trichotillomania is a psychological disorder characterized by the uncontrollable urge to pull out hair from the scalp, eyebrows, or beard. A person with this disorder may start by pulling just a few strands, but the behavior can progress to removing entire patches of hair.

Trichotillomania is a manageable disorder with evidence-based treatments, though symptoms can recur. Early intervention improves long-term outcomes. The treatment plan should be guided by a psychiatrist, who may prescribe medication for anxiety or depression, along with therapy sessions with a psychologist.

Starting treatment early is important, as trichotillomania can take a long time to manage. In some cases, it may lead to bald spots or even complete hair loss. People with this condition may also swallow the pulled hair, which can lead to serious complications due to the buildup of hair in the stomach or intestines. When pulled hair is ingested, it can accumulate into a trichobezoar in the gastrointestinal tract, sometimes requiring endoscopic or surgical removal to avoid obstruction or perforation.

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Main symptoms

Trichotillomania, often referred to as hair-pulling disorder, can cause symptoms such as:

  • Constantly touching or playing with hair

  • Repeatedly pulling or twisting hair strands, including eyebrow or eyelash hair

  • Noticeable areas on the body or scalp where hair is missing

  • Chewing, biting, or swallowing strands of hair

  • Feeling relief or pleasure after pulling out hair

People with trichotillomania may also experience deep feelings of shame or sadness, especially when the hair loss becomes noticeable and leads to visible bald spots.

In addition, hair pulling may worsen during certain situations, such as periods of increased stress or anxiety, or even in moments of relaxation, like watching TV, going to the beach, or driving.

Confirming a diagnosis

Diagnosis is usually made by a psychiatrist or psychologist, often with the help of family or friends. It involves observing behaviors, checking for visible hair loss on the scalp, and, in some cases, identifying symptoms like abdominal pain, nausea, or vomiting caused by ingesting large amounts of hair.

The diagnosis may also be supported by the DSM-5 diagnostic criteria for trichotillomania, which include:

  • Recurrent hair pulling leading to hair loss

  • Repeated attempts to decrease or stop the behavior

  • Significant distress or impairment in social, occupational, or other important areas of functioning

  • The behavior is not better explained by another medical or psychiatric condition

Possible causes

The exact causes of trichotillomania are not fully understood, but certain factors may increase the risk of developing the condition. These include childhood trauma, depression, obsessive-compulsive disorder, anxiety, or chronic stress.

Some studies suggest that changes in specific areas of the brain may play a role in the development of this disorder. Neuroimaging and pharmacological studies point to alterations in frontostriatal pathways and glutamate signaling as contributing factors in hair-pulling behaviors.

People with a family history of trichotillomania are also more likely to develop the same condition. Although it can occur at any age, trichotillomania is most common in children between the ages of 9 and 13.

Comorbidities

Common co-occurring conditions include major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, and other body-focused repetitive behaviors like skin-picking disorder.

How treatment is done

Trichotillomania is treatable, and the treatment plan should be managed by a psychiatrist. While no medications are currently FDA-approved specifically for trichotillomania, some options may help.

Medications

Some medications the doctor can consider prescribing to treat this condition include:

  • SSRIs (selective serotonin reuptake inhibitors): These may help some individuals but tend to show inconsistent results.

  • N-acetylcysteine (NAC): This glutamate modulator has shown medium-to-large effect sizes in reducing hair-pulling symptoms in adults.

Medications may be prescribed especially when trichotillomania occurs alongside conditions like depression or obsessive-compulsive disorder.

Psychotherapy

A psychologist may recommend psychotherapy, particularly cognitive behavioral therapy (CBT), which is often effective in managing this condition.

  • Habit reversal training (HRT): Considered the gold-standard behavioral therapy. It involves developing awareness of pulling urges and replacing the behavior with alternative responses.

  • Stimulus control techniques may be used alongside HRT to limit access to triggering environments or routines.

Treatment approaches may vary depending on the patient's symptomology.

Lifestyle changes for mild cases

In milder cases, small daily habit adjustments may help reduce the behavior, such as:

  • Doing activities that keep the hands busy, like gardening, painting, or cooking

  • Wearing a headband or hoodie, especially at night

  • Brushing or washing the hair to replace the urge to pull it out

Many patients also benefits form practicing relaxation techniques, meditation, or yoga to reduce anxiety and stress

Relapse prevention and support

Ongoing support is essential, especially for long-term management:

  • Maintenance therapy sessions can reinforce progress and prevent relapse.

  • Support groups may provide encouragement and shared strategies.

  • Symptom tracking tools such as the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) can help monitor behavior over time.

Educational resources are available from organizations like the TLC Foundation for Body-Focused Repetitive Behaviors and the Anxiety and Depression Association of America (ADAA).

Possible complications

The main complications of trichotillomania include bald spots, hairless patches on the scalp, missing eyebrows or eyelashes, beard hair loss, and digestive issues caused by hair buildup in the stomach or intestines.

To help manage symptoms, it's important to reduce stress and anxiety.

Update History
We regularly update our content with the latest scientific information to maintain an exceptional level of quality.
  • 8 July, 2025 (Current version)
    Updated by Daisy Oliveira - Registered Nurse
  • 7 July, 2025
  • Created on July, 2025

References
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