Pronounced as “trik-o-til-o-MAY-nee-uh”, trichotillomania is a hair pulling disorder than often results in bald patches which cause significant distress for the person who experiences them. They can go to great lengths to hide these bald patches, caused by pulling their hair, and often suffer in secret. It can interfere with social life and even work life as they can feel like they need to hide from the world when their bald patches are too visible to disguise easily.

The official definition of trichotillomania goes something like this:

Trichotillomania, sometimes called hair pulling disorder, is a medical condition that involves recurring, overwhelming urges to pull out hair from your eyelashes, eyebrows, scalp or other parts of your body. 

Trichotillomania used to be classified as an impulse control disorder but is now considered an obsessive-compulsive related disorder in the latest version of the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DS-5, American Psychiatric Association).

Although many popular articles describe trichotillomania as a mental disorder, being labelled as having a “mental disorder” isn’t particularly helpful for people who have this condition as it can actually be detrimental to the recovery process. Think of it this way – compulsive nail biters are not labelled as having a mental disorder. Most people see nail biting as a habit that can be broken, and don’t place the stigma of a ‘mental disorder’ upon it.

For people trying to stop long term hair pulling, it can be helpful to view trichotillomania in the same light: an unwanted habit you have the power to overcome once you find techniques that work for you.

If you’re researching into trichotillomania for a friend or family member who suffers from it, it’s important to keep in mind that it’s not as easy as just “stopping”. It’s a serious deep-rooted condition that requires a lot of help to overcome – often in the form of cognitive behavioural therapy and habit reversal techniques taught by a qualified therapist who has experience in treating trichotillomania.

People with trichotillomania have varying levels of it. For some people, it’s mild enough to just be a slight inconvenience. But for others, the ongoing intense urges to pull their hair can feel devastating – particularly when the effects of trichotillomania have such a visible effect on their physical appearance.

Random fact: 90% of adult trichotillomania sufferers are women.

Symptoms of Trichotillomania

Symptoms of trichotillomania include:

  • repeatedly pulling your hair out over weeks, months or years, usually from your scalp, eyelashes or eyebrows but sometimes from other parts of your body.
  • An overwhelming feeling that specific hairs must be pulled out, often in conjunction with a belief that the root of those specific hairs need to be removed.
  • A sense of relief or release when the hair is pulled out.
  • Bald areas on the scalp or other areas of your body, including patchy or missing eyebrows and eyelashes.
  • Trying to stop pulling out your hair, but without success.

Types of Hair Pulling

People with trichotillomania are usually affected by 2 different “styles” of hair pulling, with the urge to pull their hair falling into these two different categories. The same person might do both types, sometimes on the same day or sometimes in phases months apart.

Deliberate hair pulling: This type of hair pulling is usually precedented by an overwhelming urge to pull, and a strong feeling that specific hairs or hairs in a specific area need to be pulled out. When experiencing this type of urge to pull, the person can’t concentrate on anything else until they’ve succeeded in pulling out the “right hairs”.

Absent-minded hair pulling: This type of hair pulling is usually done while the person is doing something mindless such as watching TV or reading. They often don’t notice they’re doing it until they suddenly snap out of this trance-like state and realize they’ve been pulling their hair out.

It’s quite common for people with trichotillomania to start with only deliberate hair pulling in the early phases of their condition, then gradually incorporate more absent-minded hair pulling over time as the habit becomes more deeply engrained in their routine.

Certain physical positions or actions might trigger a hair pulling episode, such as touching their eyelashes or brushing their hair.

The Emotional Aspect of Trichotillomania

There is a huge emotional component to this condition, and it’s very complex. People with trichotillomania often experience a rush of conflicting emotions in quick succession, and this can contribute to increased levels of anxiety and depression in many people.

Positive Emotions: During an episode of deliberate hair pulling, the relief and release of built-up tension upon pulling out the “right” hair leads to a rush of endorphins which result in positive feelings. They can feel happy, accomplished, relieved, relaxed and calm immediately upon pulling out their hair.

Negative Emotions: Once the positive emotions fade away after an episode of deliberate hair pulling, or immediately after an episode of absent-minded hair pulling, they will often experience feelings of horror, guilt, shame, panic, disgust and sadness.

Causes of Trichotillomania

It’s not known what causes trichotillomania, and more research needs to be done for any valid answers. Some studies have uncovered patterns that they believe to indicate correlating factors, but these research groups are too small to produce any conclusive evidence.

You’re most likely to develop trichotillomania between the ages of 10 and 13 years old. Younger infants can also suffer from hair pulling but this is usually mild and goes away without treatment.

Some of the theories around factors that increase the risk of developing trichotillomania include:

Stress: High stress levels may trigger trichotillomania in some people.

Chemical imbalance: The brain’s chemical signals (neurotransmitters) don’t work properly, resulting in overwhelming urges that result in you pulling your hair. 

Genetics/Exposure: If you have an immediate family member with trichotillomania, you’re more likely to develop it yourself.

Some experts consider trichotillomania to be a subcategory of Obsessive Compulsive Disorder (OCD).

How to Stop Trichotillomania

There are different ways to stop trichotillomania, and it’s important for you to explore which ones are right for you. Many of the ways to stop trichotillomania fall into the category of habit reversal techniques, and you’ll learn these if you see a cognitive behavioural therapist.

If you think you have trichotillomania, it’s always a good idea to speak to your doctor who can give you an official diagnosis and refer you to an experienced cognitive behavioural therapist.

It’s important to explore the different types of trichotillomania treatment to see what works for you. Treatment of trichotillomania can be complicated, and most of the techniques you’ll try will require time and practice. People with trichotillomania often try several strategies to cope with their urge to pull before they find something that works for them.

Do not get discouraged if you don’t stop pulling right away, or the urge to pull comes back temporarily after a period of being pull-free. Once you start treating your trichotillomania, the coping mechanisms and techniques will eventually become automatic habits to you and it will be increasingly easier to stop pulling out hair in the long term.

Ways to hide Trichotillomania

Many people with trichotillomania feel like they need to hide this condition due to feeling shame and embarrassment. For people who pull their eyelashes, false eyelashes can give the illusion of a full set of thick eyelashes. For people who pull from their scalp, hair toppers or wigs are often used to conceal bald patches. And for people who pull their eyebrows, microblading is a popular semi-permanent method to hide the missing hairs due to individual hair strokes being “tattooed” on.

What type of people have trichotillomania?

You’d be surprised at how many people have trichotillomania – it’s estimated that between 1-2% of the population has it! It affects people of all races, socio-economic backgrounds, ages, professions, and locations. It even affects supermodels: Victoria’s Secret Angel, Sara Sampaio, opened up about her trichotillomania on Instagram.

Dealing with shame

If you suffer from trichotillomania, it’s important to not let the condition define you. You are beautiful and amazing with or without hair – your skills, personality, and the way you treat others are what make you YOU and no amount of hair pulling will ever change that. People love you for who you are, not how much hair you have.

It’s easy to fall into feelings shame and embarrassment when you have visible bald patches, but try telling yourself that they are just skin. Seriously, bald patches are just skin! You have so much skin on display on the rest of your body, what difference does a bit more visible skin make? There’s no hair police enforcing some kind of global rule that we all need to have hair in exactly the right places.

Yes, it might be a bit annoying to fill in your eyebrows or put on false eyelashes or a wig. It’s an inconvenience, for sure. But don’t feel shame around it – think of it as being just one extra step in your daily routine. Or if you feel ready, go out without covering your bald patches up! You’ll soon notice that people out there in the world are too busy worrying about themselves and their own lives to care about whether you have all your hair or not.

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