By: Casey Clark, writer, content strategist and BFRB awareness advocate
Trichotillomania, or hair pulling, is a mental health condition that's more common than you might think even though many people don't talk about it openly. According to the Massachusetts General Hospital Trichotillomania Clinic, it is estimated that 5-10 million Americans are affected by trichotillomania. That statistic goes to show just how many people are impacted by this hair pulling condition — even celebrities like Amy Schumer.
Ahead, we've gathered some information about what causes trichotillomania, trichotillomania symptoms and trichotillomania treatment options. By learning more about trichotillomania, it serves as a starting point on the trichotillomania recovery journey for you or your loved one.
What is trichotillomania?
Trichotillomania is a type of body-focused repetitive behavior (BFRB) that involves the pulling of hair from one's body. The most commonly heard of places that people usually pull from are the scalp, eyebrows, and eyelids. That said, hair can be pulled from the pubic area, armpits, legs, and other regions where hair typically grows.
Trichotillomania falls under the classification of Obsessive Compulsive Disorder (OCD) and Related Disorders. It is a self-regulation behavior used to self-soothe and relieve stress, exhaustion, boredom and other dysregulation. While it may feel "good" in the moment, individuals with trichotillomania often are left feeling ashamed and embarrassed of their appearance. The shame stemming from unwanted hair pulling may lead to social withdrawal isolation, and depression.
According to University of Michigan Medicine, the typical age of onset for trichotillomania is between 10 and 13 years old. After puberty, women are five to 10 times more likely to be diagnosed with trichotillomania. Though it appears women are more affected by trichotillomania, recent research suggests that these behaviors are equally common in men and women.
"Women tend to seek out support more often than men because there are fewer socially acceptable strategies to manage the behavior," shares Libby Gordon, LCSW, therapist and founder of The BFRB Space. While men may be comfortable simply shaving their head or beard, "women are socially expected to frequently improve their hair, eyebrows, eyelashes, etc and when working to inspect and improve, the BFRB can quickly get out of control,” Gordon says.
Trichotillomania usually follows individuals through their life with periods of activity followed by those of remission. This cycle makes trichotillomania a chronic condition.
Are there different types of trichotillomania?
Yes, there are different types of trichotillomania. For starters, the region where one pulls can be different whether that's from the eyebrows, eyelids, scalp, armpit, pubic area, etc.
In terms of the actual behavior itself, it can be either automatic or focused depending on the individual.
Automatic pulling is described as pulling out hair without realizing they are doing it until it's too late. It’s as though the hands are on autopilot. For example, one might have an episode of hair pulling and then look down to realize they've just pulled out a section of eyelashes. This often leaves people with feelings of guilt and shame that they've just damaged their hair, and have either hindered their hair regrowth, or have to start the trichotillomania recovery process all over again.
On the other hand, focused pulling refers to pulling out hair intentionally. For example, one may stand in front of a mirror and look at the different hairs to see which one looks like it's ready to be pulled.
In both of these cases, the person is not in control as the behavior is rooted in the primal self-regulatory part of the brain.
What causes trichotillomania?
There is no clear cause for trichotillomania. That said, it is recognized that some individuals may have a genetic predisposition while others may develop trichotillomania during an intense period of stress. Hormonal change may also impact trichotillomania incidence rates.
For those who already have trichotillomania, there are settings and scenarios that can make the pulling worse. Hair pulling is more likely to occur when one is bored, isolated, or in private whether that's in a bedroom, bathroom, or office cubicle.
How do doctors treat trichotillomania?
It is important to find a treatment professional with training for trichotillomania treatment. There are a few evidence-based treatments for trichotillomania, including habit reversal training (HRT).
Habit Reversal Training (HRT)
Habit reversal training is one of the first lines of treatment for individuals with trichotillomania.
"The first step in HRT is developing awareness of the behavior, triggers, and the consequences," says Gordon. This is where an awareness-enhancing device can come to aid in the process. "In the second phase of HRT, it's about finding strategies to make recovery easier, and eventually making choices to get relief in other ways."
HRT can take time to both learn and implement, but once individuals get the gist it can be very helpful.
Acceptance and Commitment Therapy (ACT)
For those with trichotillomania, the urge to pull will rarely ever go away completely although there may be long periods of time without pulling for some individuals. That said, it's important to find ways to manage the trichotillomania urges. ACT can help people to accept that they may have the hair pulling urges and can also commit to finding healthier alternatives and coping strategies.
Medication
There is no FDA-approved medication for trichotillomania. You'll want to speak with a psychiatrist experienced with treating trichotillomania to see if medication might be an option for you.
Selective serotonin re-uptake inhibitors (SSRIs) may help individuals manage symptoms associated with trichotillomania such as depression, anxiety, and obsessive-compulsive disorder.
Recent reports suggest that N-acetylcysteine, a compound that affects brain chemicals like glutamate, might help reduce symptoms of trichotillomania.
Is trichotillomania dangerous?
Trichotillomania is not typically life-threatening, but it can be dangerous in several ways. The physical effects of hair-pulling can lead to damage to the scalp, skin, or nails, causing scarring, infections, or other health issues. In some cases, individuals may also ingest the hair they pull, which can lead to the formation of hairballs in the stomach or intestines (trichobezoars), causing pain or even obstruction that may require surgery.
Beyond the physical risks, trichotillomania can also have serious emotional and psychological consequences. It is often linked with feelings of shame, guilt, anxiety, and depression, which can significantly impact a person's mental health. While there have been reports of individuals with trichotillomania experiencing suicidal thoughts, the exact rate of suicide risk among people with the disorder is not well-established due to a lack of research in this area. The emotional distress caused by the condition can lead to isolation or a reduced quality of life. However, with appropriate and evidence-based trichotillomania treatment, individuals can manage their symptoms and improve their well-being.
Finding trichotillomania support
For many people, trichotillomania is a lifelong condition they deal with that ebbs and flows in severity. Having people in your corner who can relate to what you're going through and support you during those hard times can be very helpful to maintaining successful recovery.
"For some (not all), trichotillomania really thrives in a lack of awareness, so we need supportive people to help with awareness building and behavior change," says Gordon.
You can find trichotillomania support via BFRB Changemakers monthly peer-led support groups and HabitAware’s Active Online Community that allow individuals to speak with each other, have access to resources, and even the chance to speak with a lived-experience coach for support and guidance.
About the Author Casey Clark is a writer and content strategist from New York City who specializes in mental health, beauty and travel. Her work has appeared in The Wall Street Journal, HuffPost, National Geographic and more.
