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Trichotillomania

People who have trichotillomania have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows.

Trichotillomania is a type of impulse control disorder. People with these disorders know that they can do damage by acting on the impulses, but they cannot stop themselves. They may pull out their hair when they're stressed as a way to try to soothe themselves. 

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Symptoms of Trichotillomania

Besides repeated hair pulling, other symptoms may include:

  • Feeling tense before pulling hair or when trying to resist the urge to pull hair
  • Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
  • Distress or problems in work or social life due to hair pulling
  • Bare patches where the hair has been pulled out
  • Behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair

Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.

What Causes Trichotillomania?

The exact cause of trichotillomania isn't known. It may be related to abnormalities in brain pathways that link areas involved in emotional regulation, movement, habit formation, and impulse control.    

Some people with trichotillomania may also have depression or anxiety. Trichotillomania is slightly more likely if it runs in your family.

How Is Trichotillomania Diagnosed?

Trichotillomania is diagnosed based on the presence of its signs and symptoms. There is no specific test for it.

A doctor might refer someone who has symptoms of trichotillomania to a psychiatrist or psychologist, who can interview the person and see if they might have an impulse control disorder.

What Is the Treatment for Trichotillomania?

The main treatment for trichotillomania is a type of behavior therapy called habit reversal training. Basically, this means replacing a bad habit with something else that's not harmful.

With this approach, people with trichotillomania first learn to identify when and where they have the urge to pull hair. They also learn to relax and do something else, that doesn't hurt them, as a way to help ease tension when they feel the urge to pull their hair.  

It might be as simple as making a fist with the hand that they would use to pull out the hair. Therapy can also address any unhelpful thinking that might be adding to the stress that triggers the behavior.

Medication may also be part of the treatment program. A type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) might be useful in helping to curb very intense urges. Atypical antipsychotics such as olanzapine or aripiprazole also may sometimes be used, either alone or in combination with an SSRI.

What Complications Are Associated With Trichotillomania?

Infection, skin damage, and permanent hair loss are possible complications of trichotillomania. The hair loss and skin damage can lead to problems with self-esteem and body image. In extreme cases, some people might avoid social situations in order to hide the hair loss.

Can Trichotillomania Be Prevented?

There is no proven way to prevent trichotillomania, but getting treatment as soon as symptoms start can be a big help. Learning stress management is also a good idea, since stress often triggers the hair-pulling behavior.

WebMD Medical Reference

Reviewed by Joseph Goldberg, MD on February 11, 2014
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