Trichotillomania

Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off. Patients are unable to stop this behavior, even as their hair becomes thinner.

Causes

Trichotillomania is a type of impulsive control disorder. Its causes are not clearly understood.

It may affect as much as 4% of the population. Women are four times more likely to be affected than men.

Symptoms

Symptoms usually begin before age 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.

These symptoms are usually seen in children:

  • An uneven appearance to the hair
  • Bare patches or all around (diffuse) loss of hair
  • Bowel blockage (obstruction) if people eat the hair they pull out
  • Constant tugging, pulling, or twisting of hair
  • Denying the hair pulling
  • Hair regrowth that feels like stubble in the bare spots
  • Increasing sense of tension before the hair pulling
  • Other self-injury behaviors
  • Sense of relief, pleasure, or gratification after the hair pulling

Most people with this disorder also have problems with:

  • Feeling sad or depressed
  • Anxiety
  • Poor self image

Exams and Tests

People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).

A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.

Treatment

Experts don't agree on the use of medication for treatment. However, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown effective in reducing some symptoms. Behavioral therapy and habit reversal may also be effective.

Outlook (Prognosis)

Trichotillomania that begins in younger children (fewer than 6 years old) may go away without treatment. For most, the hair pulling ends within 12 months.

For others, trichotillomania is a lifelong disorder. However, treatment often improves the hair pulling and the feelings of depression, anxiety, or poor self image.

Possible Complications

People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.

Prevention

Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.

Alternative Names

Trichotillosis; Compulsive hair pulling

References

Morelli JG. Disorders of the hair. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 661.

Kratochvil CJ, Bloch MH. Trichotillomania across the life span. J Am Acad Child Adolesc Psychiatry. 2009;48:879-883.

Update Date: 4/20/2012

Reviewed by: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY (2/18/2010).

Notice: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2012, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.