Table of ContentsView AllTable of ContentsSymptomsCauses and Risk FactorsDiagnosisTreatmentCoping

Table of ContentsView All

View All

Table of Contents

Symptoms

Causes and Risk Factors

Diagnosis

Treatment

Coping

Close

Trichotillomania (TTM), also known as hair-pulling disorder, is a condition in which hair is repeatedly pulled out, twisted, or broken off from any part of the body for non-cosmetic reasons. People with trichotillomania pull out hair on their heads, eyelashes, eyebrows, and/or other parts of the body, such as the underarm, pubic, chin, chest, or leg areas. They may do this intentionally or unconsciously.

This condition can lead to significant hair loss, but it is treatable. Recognizing the signs early on can ensure that people get the treatment they need to prevent further damage.

At a GlanceSymptoms of trichotillomania include recurrent hair pulling that leads to hair loss, feelings of tension before the behavior, and a sense of gratification or relief when engaging in the behavior. Explanations for such behavior aren’t clear, but experts believe that genetics and family history play a role. Understandably, people may try to hide the behavior, making diagnosing it more complex.Trichotillomania treatments typically involve cognitive behavioral therapy, habit reversal training, or exposure therapy. Medication has not been shown to be effective, but some medications may be prescribed to treat symptoms of co-occurring conditions like anxiety or depression. If you are coping with hair pulling disorder, you may also find it helpful to utilize relaxation techniques, distractions, and social support to help manage your behaviors.

At a Glance

Symptoms of trichotillomania include recurrent hair pulling that leads to hair loss, feelings of tension before the behavior, and a sense of gratification or relief when engaging in the behavior. Explanations for such behavior aren’t clear, but experts believe that genetics and family history play a role. Understandably, people may try to hide the behavior, making diagnosing it more complex.Trichotillomania treatments typically involve cognitive behavioral therapy, habit reversal training, or exposure therapy. Medication has not been shown to be effective, but some medications may be prescribed to treat symptoms of co-occurring conditions like anxiety or depression. If you are coping with hair pulling disorder, you may also find it helpful to utilize relaxation techniques, distractions, and social support to help manage your behaviors.

Symptoms of trichotillomania include recurrent hair pulling that leads to hair loss, feelings of tension before the behavior, and a sense of gratification or relief when engaging in the behavior. Explanations for such behavior aren’t clear, but experts believe that genetics and family history play a role. Understandably, people may try to hide the behavior, making diagnosing it more complex.

Trichotillomania treatments typically involve cognitive behavioral therapy, habit reversal training, or exposure therapy. Medication has not been shown to be effective, but some medications may be prescribed to treat symptoms of co-occurring conditions like anxiety or depression. If you are coping with hair pulling disorder, you may also find it helpful to utilize relaxation techniques, distractions, and social support to help manage your behaviors.

Symptoms of Trichotillomania

According to the TLC Foundation for Body-Focused Repetitive Behaviors, trichotillomania can come and go, stopping for days or even months before reoccurring. The hair-pulling behavior has even rarely been reported to happen during sleep.

Trichotillomania is classified in the most recent “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR) as anobsessive-compulsive spectrum disorder.

While trichotillomania can manifest differently depending on the person, it generally has five distinct characteristics:

The following rituals and behavioral patterns often precede pulling:

Research indicates that hair is most commonly pulled from the scalp, eyebrows, eyelashes, and pubic area. However, pulling may also focus on the limbs, underarms, and chest.Such behavior leads to a considerable amount of distress and difficulties in other life areas.

Trichotillomania Causes and Risk Factors

While no one knows for sure what causes trichotillomania, biological forces as well as behavioral, learning, and psychological components are thought to play a role.

Family History

Having a family member or relative with trichotillomania increases the risk for the condition, which suggests that there may be a heritable component to the condition. One twin study suggested a heritability estimate of 76.2%, indicating that genetics plays a significant role. Another twin study conducted in the UK estimated that heritability was around 32%.

Co-Occurring Conditions

Evidence suggests that trichotillomania is highly comorbid with other conditions. As many as 80% of people with hair pulling disorder also have another psychiatric disorder.Conditions that may occur alongside it include:

An estimated 20% of people with trichotillomania also have trichophagia, which involves consuming the hair they have pulled, resulting in gastrointestinal problems that necessitate surgical treatment.

How Is Trichotillomania Diagnosed?

Because trichotillomania can resemble other medical conditions associated with hair loss such as alopecia areata, diagnosis of trichotillomania often requires both a dermatological and psychiatric evaluation. Diagnosis may be complicated as alopecia areata itself can sometimes trigger trichotillomania.

Trichotillomania is a relatively rare illness, affecting 1% to 2% of the population. Trichotillomania can affect people of all ages; however, it appears to be much more common among children and adolescents than adults. Roughly 90% of adults with the condition are female.

Young Children

In very young children, trichotillomania has been compared to other habits such as thumb sucking or nail-biting. Children less than 5 years old often pull their hair out unknowingly. In the same way that thumb-sucking stops spontaneously for most children, the majority of children who begin to pull their hair at this early age will stop on their own.

Preadolescents and Young Adults

In addition, these individuals often have oral rituals associated with hair pulling, such as chewing or licking the lips or even eating hair. Studies suggest that around 1% to 3% of adults in the U.S. experience trichotillomania at some point during their lives.However, the exact prevalence is difficult to determine because it is likely underreported.

Treatment for Trichotillomania

Treatment of trichotillomania is often unnecessary for very young children as they usually grow out of it. However, for people with adolescent-onset trichotillomania, treatment may be necessary, especially if it is suspected that the person is also consuming the pulled hair, which can cause dangerous blockages in the gastrointestinal system.

Psychotherapy

Cognitive behavioral techniqueshave demonstrated some efficacy in treating trichotillomania. Prominent among these is habit reversal therapy, which aims to help people develop skills to reduce their harmful behaviors, including:

Habit reversal training(HRT) is another first-line treatment that involves helping people become more aware of their triggers, learn relaxation strategies, and develop competing responses. Othertypes of therapythat may be helpful include dialectical behavior therapy (DBT), mindfulness training,acceptance and commitment therapy(ACT), andexposure therapy.

Overview of Habit Reversal Training

Medication

Currently, there is limited evidence that medications such asselective serotonin reuptake inhibitors (SSRIs)ortricyclic antidepressants (TCAs)are consistently effective in treating trichotillomania, so the FDA has not approved any medications for specifically treating the condition.

However, several types of medications have been tried, particularly if there are co-occurring mood, anxiety, or obsessive-compulsive symptoms. These include:

Coping With Trichotillomania

While the best way to cope with trichotillomania will depend on your age and severity of symptoms, there are a few strategies you or your child to try:

If you or a loved one are struggling with trichotillomania, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with trichotillomania, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

OCD Subtypes: Types of Obsessive-Compulsive Disorder

10 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

The TLC Foundation for Body-Focused Repetitive Behaviors.What is trichotillomania (hair pulling disorder)?

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

Woods DW, Houghton DC.Diagnosis, evaluation, and management of trichotillomania.Psychiatr Clin North Am. 2014;37(3):301-17. doi:10.1016/j.psc.2014.05.005

Melo DF, Lima CDS, Piraccini BM, Tosti A.Trichotillomania: What do we know so far?Skin Appendage Disord. 2022;8(1):1-7. doi:10.1159/000518191

Grant JE, Dougherty DD, Chamberlain SR.Prevalence, gender correlates, and co-morbidity of trichotillomania.Psychiatry Res. 2020;288:112948. doi:10.1016/j.psychres.2020.112948

Henkel ED, Jaquez SD, Diaz LZ.Pediatric trichotillomania: Review of management.Pediatr Dermatol. 2019;36(6):803-807. doi:10.1111/pde.13954

Merck Manual.Trichotillomania.

Grant JE, Chamberlain SR.Trichotillomania.Am J Psychiatry. 2016;173(9):868-874. doi:10.1176/appi.ajp.2016.15111432

Grant JE.Trichotillomania (hair pulling disorder).Indian J Psychiatry. 2019;61(Suppl 1):S136-S139. doi:10.4103/psychiatry.IndianJPsychiatry_529_18

Bruce TO, Barwick LW, Wright HH.Diagnosis and management of trichotillomania in children and adolescents.Paediatr Drugs. 2005;7(6):365-76. doi:10.2165/00148581-200507060-00005Falkenstein MJ, Mouton-Odum S, Mansueto CS, Golomb RG, Haaga DA.Comprehensive behavioral treatment of trichotillomania: a treatment development study.Behav Modif. 2016;40(3):414-38. doi:10.1177/0145445515616369

Bruce TO, Barwick LW, Wright HH.Diagnosis and management of trichotillomania in children and adolescents.Paediatr Drugs. 2005;7(6):365-76. doi:10.2165/00148581-200507060-00005

Falkenstein MJ, Mouton-Odum S, Mansueto CS, Golomb RG, Haaga DA.Comprehensive behavioral treatment of trichotillomania: a treatment development study.Behav Modif. 2016;40(3):414-38. doi:10.1177/0145445515616369

Meet Our Review Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?HelpfulReport an ErrorOtherSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?HelpfulReport an ErrorOtherSubmit

What is your feedback?