Trichotillomania: Causes and Treatments

May 18th, 2017          Written by a Staff Member at Hair Loss in Women

Chronc Hair Pulling or Trichotillomania

Trichotillomania (also known as trichotillosis or hair pulling disorder) is an impulse control disorder, which usually happens when a person has a hard time stopping themselves from pulling their hair on their scalp, eyebrows and eyelashes. Sufferers of this disorder are aware that this irresistible and impulsive habit is damaging, but they find it hard to stop themselves. One of the main reasons why they tend to pull their hair uncontrollably is stress. They exhibit the habit as a means of soothing themselves.

Hair pulling is not solely a nervous habit, although there are times when stress and anxiety exacerbate or trigger it. One can also associate the habit with other feelings or emotions including boredom. It is also important to note that trichotillomania does not only affect those who are dealing with stress, trauma, and anxiety. It doesn’t solely affect those who are emotionally disturbed. Those who are genuinely happy, satisfied, and well-adjusted may also suffer from it at one point in their lives.

Signs and Symptoms of Trichotillomania/Hair Pulling Disorder

You will know that you or someone you know has trichotillomania if the following signs are exhibited aside from repeated hair pulling:

  • Tension before hair pulling or whenever you try to stop the urge of pulling your hair
  • Getting relief, satisfaction, or pleasure after satisfying the urge to pull hair
  • Dealing with extreme distress and frustration both socially and at work because of the uncontrollable hair pulling habit
  • Visible patches at the places where you pulled your hair
  • Behaviors like constantly twirling the hair or inspecting their root, chewing or eating hair, and pulling hair between your teeth
  • Constant attempts to stop or reduce the tendency of hair pulling

Sufferers frequently pull their hair when they are working on their computer, writing, reading, watching TV, talking with someone on the phone, or even when falling asleep. Some sufferers are aware that they have the habit, while others are not. Some people tend to pull their hair in private, while others do it publicly while also performing the other activities above.


Treating trichotillomania should start with identifying its causes. The good thing about treating the root cause first is that the symptoms, including hair pulling, will also be automatically relieved.

1. Form of Self-Harm

Trichotillomania is one form of self-harm. This means that it can be triggered by a person’s desire to injure themselves deliberately to relieve themselves temporarily from emotional distress. Self-harm is accompanied by pain, which causes the brain to release endorphins or natural pain-killing chemicals. These chemicals tend to provide the sufferer with a sense of wellbeing and relief for a short period from their negative mental/emotional state, such as a bad mood, self-loathing, guilt, anxiety, and low self-esteem.

Some tend to self-harm by pulling their hair as a means of coping with traumatic experiences like emotional, physical or sexual abuse. For instance, a sexually abused female may harm herself by pulling out her hair to make herself less feminine or attractive.

2. Brain Abnormalities

The results of brain scans conducted on those who have trichotillomania revealed that they have brain abnormalities.

3. Genetics

Some trichotillomania sufferers acquired the condition through genetics; this means that they either inherited these from their family members, or there was a change in a specific gene that caused the problem.

4. Inadequate Serotonin

Serotonin refers to the feel-good chemical found in your brain. Lack of this chemical may cause you to exhibit unwanted and impulsive behaviors such as pulling the hair. The good news is that you can increase the serotonin level in your body by taking a SSRI (selective serotonin reuptake inhibitor). Aside from increasing your serotonin level, it also works effectively in treating trichotillomania.

5. Negative Emotions

Uncomfortable and negative emotions like anxiety, frustration, tension, stress, fatigue and loneliness can also trigger someone to pull their hair. This habit is their way of coping with these negative emotions.

6. Age

The disorder usually develops during or before early teens. In most cases, it becomes apparent between the ages 11 and 13. Some infants are also prone to developing the habit, but it’s usually only mild and it tends to heal on its own as the baby grows, without the need for any treatment.

Possible Treatments

1. Medications

There are a few medications designed to deal with the symptoms of trichotillomania. The problem is that most of these medications don’t get the approval of the FDA (Food and Drug Administration) when it comes to curing the disorder completely. Still, they are effective in controlling the symptoms including hair pulling. It’s also advisable to discuss the benefits, risks, and potential side effects of taking the specific medication suggested by your healthcare professional.

One of the medications that you can take is the SSRI (selective serotonin re-uptake inhibitor). This is useful not only in controlling the symptoms of the disorder but also in treating anxiety disorder and depression. The most recommended SSRIs for children below 18 are fluoxetine and sertraline. They should, however, take it only when a mental health specialist like a psychiatrist supervises them.

Another medication that your doctor may prescribe to treat trichotillomania is clomipramine. It is usually used in treating obsessional conditions and depression. However, a minor below the age of 18 who needs to take this drug should get the supervision of a child specialist or an adolescent psychiatrist. It may be effective in minimizing hair-pulling behaviors.

Other medicines that are known to benefit trichotillomania sufferers are olanzapine, an atypical antipsychotic drug and N-acetylcysteine, which is an amino acid that stimulates the production of neurotransmitters designed to improve your mood. Just make sure that you thoroughly discuss the suggested medications with your doctor. There should be a balance between the benefits of the medicine and its potential side effects.

2. Hair Reversal Training

One psychotherapy treatment designed for trichotillomania is hair reversal training. This training gives you an easier time recognizing situations wherein you will most likely pull your hair. You may then substitute this with other behaviors. For instance, you may be trained to clench your fist whenever you feel the urge to pull your hair so you can stop it. Instead of moving towards your hair, you may also redirect your hand to your ear.

Hair reversal training usually comes with 4 steps. The first one is awareness training, which requires you to keep detailed records of all episodes related to hair pulling. You also need to record the circumstances surrounding each episode.

The second step is relaxation training. This trains you to calm your own nervous system, so you can focus and center yourself.

The third step is called breathing retraining. In this step, you will learn how to breathe from your diaphragm as a means of boosting your focus and achieving the highest form of relaxation.

The last step would be competing response training. This step requires you to tense your hands and forearms that are not compatible with hair pulling.

3. Cognitive Behavioral Therapy (CBT)

You can blend this behavioral or psychotherapy treatment with hair reversal training to improve its effect. Designed to challenge or examine any distorted beliefs that you have about hair pulling, this therapy can help you finally recover from the disorder. It targets all the thoughts that you have about yourself, including negative ones, your relationship with other people, and the way you relate to everyone and everything around you.

The major goal of CBT is to help change your unwanted behaviors. For instance, it aims to minimize your hair pulling episodes. Some people also consider this as a habit reversal therapy, which does the following:

  • Educate you about the disorder, as well as how you can specifically treat it.
  • Increase your awareness about why and when you pull your hair – An example would be the tendency to pull your hair when you are in a stressful situation.
  • Learn new approaches or response that you can carry out whenever you have the urge to pull your hair.
  • Create barriers designed to avoid hair pulling – For instance, you may wear a hat if you tend to pull your hair from the scalp.
  • Involve your loved ones in terms of treating your condition – They may praise or encourage you to get rid of the habit.

4. Family Therapy

Trichotillomania is a distressing condition that affects the family of those who suffer from it. Hair pulling may also be a habit designed to communicate your frustration and distress to your family. The problem is that your family may feel powerless to offer help. If this is the case, then family therapy can help. This requires the help of a therapist who will meet your entire family as a means of exploring their relationships and views and understanding problems.

The good thing about family therapy is that it makes it easier for each family member to communicate. With improved communication, the whole family will be able to work together when it comes to addressing the issue or the root cause of hair pulling. This therapy also offers support to the whole family so they can recover from all the distress and frustration caused by the condition.

5. Additional Tips

Create a sticker chart – Add a sticker to the chart every time you were able to avoid the habit of pulling your hair. Hang the chart in a place where you can easily see it. This will serve as your motivation to stop the habit.

  • Wet your hair – This can help prevent hair loss due to pulling because your hair will be slippery.
  • Try exposure therapy – This involves looking at your hair in a mirror on a daily basis. Put your hands at your back when doing this. Stare at the mirror until you notice that your urge to pull your hair lessens.
  • Make yourself busy – Avoid having too much downtime because you may get bored, which will heighten your desire to pull.
  • Keep a record or journal of your feelings – This will help you determine what specific emotions trigger the habit.
  • Meditate – Meditating can help you relax, which is beneficial if your hair pulling habit usually results from stress and anxiety.

For a list of 50 things you can do to stop pulling your hair, visit the TLC Foundation website.


Have you or anyone you know gone through trichotillomania?  Please leave a comment below.

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