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Trichotillomania (hair-pulling disorder)

Trichotillomania (trik-o-til-o-MAY-nee-uh) is a disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop.

Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.

For some people, trichotillomania may be mild and generally manageable. For others, the compulsive urge to pull hair is overwhelming. Some treatment options have helped many people reduce their hair pulling or stop entirely.

Symptoms Causes Risk factors Complications

Signs and symptoms of trichotillomania often include:

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but can be from other body areas, and sites may vary over time
  • An increasing sense of tension before pulling, or when you try to resist pulling
  • A sense of pleasure or relief after the hair is pulled
  • Shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
  • Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
  • Biting, chewing or eating pulled-out hair
  • Playing with pulled-out hair or rubbing it across your lips or face

Most people who have trichotillomania also will pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

  • Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
  • Automatic. Some people pull their hair without even realizing they're doing it, such as when they're bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.

The cause of trichotillomania is unclear. But like many complex disorders, trichotillomania probably results from a combination of genetic and environmental factors. Also, abnormalities in the natural brain chemicals serotonin and dopamine may play a role in trichotillomania.

These factors tend to increase the risk of trichotillomania:

  • Family history. Genetics may play a role in the development of trichotillomania, and the disorder may occur in those who have a close relative with the disorder.
  • Age. Trichotillomania usually develops just before or during the early teens — most often between the ages of 11 and 13 — and is often a lifelong problem. Infants also can be prone to hair pulling, but this is usually mild and goes away on its own without treatment.
  • Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, loneliness, fatigue or frustration.
  • Positive reinforcement. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.
  • Other disorders. People who have trichotillomania may also have other disorders, such as depression, anxiety or obsessive-compulsive disorder (OCD).

Although far more women than men are treated for trichotillomania, this may be because women are more likely to seek medical advice. In early childhood, boys and girls appear to be equally affected.

Although it may not seem particularly serious, trichotillomania can have a great impact on your life. Complications may include:

  • Emotional distress. Many people with trichotillomania report feeling shame, humiliation and embarrassment and experience low self-esteem, depression and anxiety because of their condition.
  • Problems with social and job functioning. Embarrassment because of hair loss may lead you to avoid social activities and occupational opportunities. People with trichotillomania may wear wigs, style their hair to disguise bald patches or wear false eyelashes. Some people may avoid intimacy for fear that their condition will be discovered.
  • Skin and hair damage. Constant hair pulling can cause abrasions and other damage, including infections, to the skin on your scalp or the specific area where hair is pulled, and can affect hair growth.
  • Hairballs. Eating your hair may lead to a large, matted hair ball (trichobezoar) in your digestive tract. Over a period of years, the hair ball can cause weight loss, vomiting, intestinal obstruction and even death.
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