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Trichotillomania: The Hair Pulling Condition

By Edited Nov 13, 2013 0 0

What is Trichotillomania?


Trichotillomania is the constant or recurrent pulling out of one’s hair.  This disorder used to be considered rare or uncommon.  However, more research shows this may not be as uncommon as once thought.  The problem with the data is that most people do not report the symptoms of trichotillomania to a mental health professional or their doctor.  They are embarrassed by the condition and my try to hide it. 


So where do the people pull the hair out from.  The simple answer is, anywhere hair is growing on the body.  The most common places for people to pull out the hair is the eyebrows, eyelashes, pubic area, and of course the head. 


I worked with one female who pulled out hair from all parts of her body.  She did still have hair on her head but not a lot.  She wore a do-rag to cover up what hair she did have because she was embarrassed to show this.  However, she also pulled out her eye brows, eye lashes and pubic hair.  I took her word for the last one but the other pulling sites where obvious. 


eyebrows and eyelashes

This hair pulling disorder caused her more than the social problems associated with her family, friends, and acquaintances.  The pulling of hair from her pubic area seemed to cause infections in the vaginal area.  Her gynecological doctor was the first health care professional to refer her to seek counseling and instructed her about what trichotillomania was.  She also stated she liked to bit the root of the hair after pulling it out.  She received some gratification in this as well.


The disorder is not just limited to adults.  I have worked with quite a few children who have trichotillomania.  Most parents think there is an anger problem that is causing the child to pull their hair out.  However, the DSM classifies it as an impulse-control disorder.  I agree there are impulse control problems with this disorder, but I tend to think of this as an anxiety problem.  All the patients I have seen have a co-occurring diagnosis of anxiety.  The causes of trichotillomania are still really unknown. 


Child with trichotillomania

Symptoms of Trichotillomania.

According to the current Diagnostic and Statistical Manuel of Mental Disorders-IV-TR (DSM)[1], the symptoms of trichotillomania are pretty clear cut. 

  • Recurrent pulling out of one’s hair resulting in a noticeable hair loss in one or multiple places on the body. 
  • The person will have a sense or tension or a strong need to pull out the hair.  The person will also feel some anxiety if they get the urge to pull the hair out and they do not do it.
  • The person will receive instant gratification when pulling the hair out.  This is tension relieve. 
  • The symptoms of trichotillomania should not be associated with other mental disorder or a dermatological disorder.


Treatment of Trichotillomania

The treatment of trichotillomania is usually associated with a behavioral modification program called Habit Reversal Training (HRT).  In HRT there are five main stages or components. 

  1. Awareness Training:  The person has to be aware of when they are doing the hair pulling.  This is accomplished by calling their attention to it when someone in the family or therapist sees it.  An awareness log is kept and processed with the therapist in the sessions.  The client will keep this log of when, where, and what was happening at the time of the hair pulling incident. 
  2. Competing Response Training:  The therapist and client will process various activities the client can do instead of pulling out hair.  This can be any immediate activity to combat it.  This is a competing response and the client will do it instead of pulling hair.
  3. Contingency management:  This is a system of rewards for achieve the goal of not pulling the hair.  Consequently, there will be negative consequences when the person does pull the hair.  This will be based on age and other factors of the client. 
  4. Relaxation Training:  There are many types of relaxation trainings and I do not want to go into details of all of them here.  For brevity’s sake I will name the ones I use.  Diaphragmatic Breathing Exercises is learning to control the breathing process and therefore controlling the anxiety or impulses.  Guided imagery is using the mind’s eye to go to what Happy Gilmore called the Happy Place. Progressive Muscle Relaxation is tensing and relaxing all the major muscle groups of the body in a detailed way. 
  5. Generalized Training:  This is where the client can generalize what was discussed and techniques learned from the therapist office to the other areas of their life.  This can include, school, home, work, etc.  The generalized training should also consider not just place, but situation, times, and other issues the client may be having. 


Children usually outgrow the disorder.  The same HRT is applied with children but must be tailored to their understanding.  The parents, guardians, teachers, and caregivers are all sought out to help with this process.  The child may not be able to keep the log and therefore, the parent and others will be looked to provide the needed information. 


Children and adults may require wigs for the condition.  One time I was doing a general psychological evaluation for a referral of anxiety.  During the process I noticed that the child had an awful a lot of hair for a child her age.  I commented on her beautiful hair and her mother laughed at me.  She pulled the wig up and showed me the hair or lack thereof that was underneath the wig.  The mother then went on to tell me about the symptoms and that was one of the reasons why she was referred to my clinic.


Adults that develop this disorder later on in life should also be evaluated to see if the disorder is the result of some other disorder or disease.  There are some significant correlations to many mental disorders and trichotillomania.  Another thing to consider with children and adults is if it could be alopecia, which is the natural falling out of hair. 


Other resources about Trichotillomania

There is actually a website dedicated to trichotillomania.  It is www.trich.org.  However, this article and that website is not a substitute for the help you can receive from your medical doctor and mental health professional.  Please seek help.  Trichotillomania may not seem like a lot but it could lead to or be the result of other serious mental conditions.


The Mayo Clinic website has some very helpful information about this disorder.  There are links to articles discussing the possible cause of trichotillomania.  However, there needs to be more research before more judgment can be assumed to causes of trichotillomania.   


Feel free to leave many any comments or ask any questions.  Take care of yourself and those around you.  Make today and everyday a great day. 

The Hair-Pulling Problem: A Complete Guide to Trichotillomania
Amazon Price: $39.95 $14.75 Buy Now
(price as of Sep 6, 2013)


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  1. American Psychiatric Association Diagnostic and Statistical Manuel of Mental Disorders IV-TR. Washington DC: American Psychiatric Association, 2000.

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