Mental Health: Trichotillomania

Trichotillomania, a hair-pulling disorder, involves an irresistible urge to pull out hair. This behavior occurs to the point of noticeable hair loss. The most common areas for hair pulling are the scalp, eyelashes and eyebrows, but may involve hair anywhere on the body.

Trichotillomania is a type of impulse control disorder. Impulse control disorders are mental illnesses that involve the repeated failure to resist impulses, or urges, to act in ways that are dangerous or harmful. People with these disorders know that they can hurt themselves or others by acting on the impulses, but they cannot stop themselves.

In children, trichotillomania occurs equally in males and females. In adults, it is more common in women than in men.

What Are the Symptoms of Trichotillomania?

A person with trichotillomania cannot control or resist the urge to pull out his or her body hair. Other symptoms that might occur with this disorder include:

• A sense of tension before pulling hair or when trying to resist the urge to pull hair
• A feeling of relief, satisfaction and/or pleasure after acting on the impulse to pull hair
• Presence of bare patches where the hair has been pulled out
• Presence of other associated behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on the hair or eating hair (called trichophagia)

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 is not yet known, but it appears to involve both biological and behavioral factors. Research has found a potential link between impulse control disorders, such as trichotillomania, and certain brain chemicals called neurotransmitters. Neurotransmitters help nerve cells in the brain send messages to each other. An imbalance of these chemicals can affect how the brain controls impulses. It also is believed that stress can trigger the impulsive behavior, and that some people continue the behavior out of habit.

In some cases, people with trichotillomania also have other disorders such as depression or anxiety. This suggests that there might be a link between these disorders and the development of trichotillomania. In addition, the risk of developing trichotillomania is slightly higher in people who have relatives with the disorder, suggesting that a tendency for the disorder may be inherited.

How Is Trichotillomania Diagnosed?

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. There are no tests to diagnose trichotillomania, although tests might be used to rule out any medical cause for the hair loss.

If trichotillomania is suspected, the doctor might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a person for an impulse control disorder.