Symptoms of hair pulling
Trichotillomania is mental health condition, known as an impulse control disorder, in which a person feels they have to pull out hair.
Hair pulling may affect as many as 4% of people and often begins in 11 to 13 year olds. It is more common in girls.
Bald patches may be noticeable if hair is tugged from the scalp, but other places may be affected, including eyelashes, eyebrows, genital area, underarm hair or facial hair.
A person may get a sense of relief from pulling hair out, but later may have negative feelings about it, such as guilt, embarrassment or low self-esteem.
Some people also eat their hair, known as trichophagia, which has a risk of hair balls forming in the stomach.
Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, false eyelashes and eyebrows.
What causes trichotillomania?
The exact cause of trichotillomania is not yet known.
Some experts believe hair pulling is a way to relieve stress or anxiety.
As it involves some compulsive behaviour, it may be related to obsessive compulsive disorder (OCD). OCD may run in families.
Other theories suggest trichotillomania may be a type of self-harm.
Brain abnormalities, a lack of the chemical serotonin in the brain and hormone changes, especially around puberty, may also contribute to hair pulling.
How is trichotillomania diagnosed?
If symptoms of trichotillomania are present, the doctor will begin an evaluation by performing a complete medical history, physical examination and discussing the feelings a person has before hair pulling and any triggers.
Any bald patches may also be checked to rule out any other conditions that may cause hair loss.
If trichotillomania is suspected, a referral to a mental health professional may be recommended.
What is the treatment for trichotillomania?
Treatment for hair pulling includes:
Medication may be recommended, including selective serotonin reuptake inhibitors (SSRIs) and clomipramine.
The NHS says clomipramine is effective at reducing hair-pulling behaviours, but the evidence for SSRIs is less strong. For under-18s, these drugs can only be prescribed under the supervision of a specialist child and adolescent psychiatrist.
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, and can have a negative impact on work and relationships. In extreme cases, some people might avoid social situations in order to hide the resulting hair loss.
People who engage in trichophagia (eating hair) are at risk of forming trichobezoars, or balls of hair, in the stomach or small intestines. Trichobezoars can lead to pain, nausea, and vomiting, bleeding, blockages, and other serious gastrointestinal problems. Surgery to remove trichobezoars or treat a bowel obstruction may be needed.
What is the outlook for people with trichotillomania?
Children often recover completely from trichotillomania. In adults, however, the disorder tends to be chronic (ongoing) and harder to treat.
Can trichotillomania be prevented?
There is no known way to prevent trichotillomania. However, getting treatment as soon as symptoms appear might help decrease any possible disruption to the person's life, family, and friendships. Stress reduction can also help, since stress often triggers the hair pulling behaviour.