When People Pull out Their Hair – The Facts About Trichotillomania

When People Pull out Their Hair - The Facts About Trichotillomania

Trichotillomania is a chronic, recurrent compulsion to pull one’s hair that results in physical as well as mental and emotional pain.

Trichotillomania is a disorder that affects 1-2% of the population, a majority of them female. Symptoms usually start in adolescence following puberty. The main feature is the recurrent compulsion to pull out one’s hair. Hair is pulled from any area of the body, the most common being scalp, eyebrows, and eyelids. Episodes of hair pulling vary over time and can be cyclical, but a person will spend a considerable amount of time doing it, sometimes several hours per day. 

Another key symptom is recurring attempts to stop or decrease hair-pulling behaviors.

Also, the behavior causes significant distress in a person’s life. This distress causes dysfunction at school, work, or in social settings are other areas of functioning. Finally, the compulsion to pull hair cannot be explained by another medical problem or another mental health problem.

There are many reasons to pull hair. In some cases, hair pulling gives an emotional release, a way to focus on a different type of pain, or a way of soothing. For some, pulling hair leads to gratification or pleasure. Not all who pull hair do so consciously. While some pull hair with full awareness, there are others who do it without noticing what is happening.

Compulsive hair pulling is a stressful disorder often hid from family and friends. A cycle of negative emotions goes with the behavior including guilt, shame, and embarrassment. Many people who suffer from compulsive hair pulling prefer isolation, withdrawing from social interaction for fear of judgment. A person is left to deal with the disorder alone, internalizing negative emotions and often struggling with depression and anxiety. Not only do those feelings spark anxiety, but anxiety can worsen hair pulling activity.

Many people who struggle with trichotillomania, or compulsive hair pulling, associate hair pulling with anxiety. One study found that out of 894 people struggling with trichotillomania, 84% of them said anxiety was associated with it. Others report that hair pulling gets worse when anxiety increases.

In addition to the mental and emotional distress of the disorder, there are physical health risks as well. Pulling hair out at the roots on the scalp can result in permanent damage. People who suffer from trichotillomania often have spots where hair no longer grows or the hair that grows is not healthy. Scabs and infections can develop on the scalp resulting in severe discomfort or disfigurement. If eyelashes are pulled, it can result in a condition called blepharitis, inflammation of the eyelids. Pulled hair that is swallowed can cause digestive problems.

Trichotillomania is a chronic, compulsive disorder that if left untreated can cause significant distress and pain. The good news is treatment is available. Therapists who specialize in treating body-focused repetitive disorders use a variety of evidence-based treatments to help clients manage symptoms and address any co-occurring issues like anxiety or depression that exacerbate hair pulling. There are many people who find hope and manage symptoms with treatment and a supportive community.


About the Author: Trudi Griffin

Trudi Griffin is a NCC Licensed Professional Counselor putting her clinical knowledge, experience, and passion for research to write about mental health for publications such as www.trichtop.com. She earned a Master of Science degree in Clinical Mental Health Counseling: Addictions and Mental Health from Marquette University (Milwaukee, WI), and is a double graduate of the University of Wisconsin Green Bay with Bachelor’s degrees in Communications and Psychology.

26 Comments

Charlotte

Is there a name for compulsive skin picking? I thought it might be a symptom of OCD but I am not sure of that.

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Sharon H

A confession: I have a form of this disorder due to overbearing stress. It started about three years ago. I don’t pull the hair out but I break off pieces near the mid-length and bottom. Sometimes I don’t realize I do it in public.

This article is very helpful, but I am already on meds and my doctors have said unless we move away from this very stressful environment, I will continue to have this behavior. But it is so good to know that there are many others suffering with this and I’m not alone. Thank you for this. It was hard for me to write but now it is “off my chest”.

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Karen Young

Sharon you are so NOT alone! Thank you for adding your important voice. The more people like you who can share their experience, the more the conversation happens and the more understanding there will be around this important issue.

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Sharon H

Thank you. It has made me feel so much better; both the article and other respondents.

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Cheryl

Overbearing stress is my cause I believe. I’m going to start online therapy ASAP. I do t know how much it will cost but I’m going to stop!! I hope…..

I remember I started when I was numbing my emotions and then I felt like the pain of pulling it out made me “feel” something.

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Karen Young

If the compulsive hair cutting is getting in the way, it might be worth an assessment. This can be a sign of obsessive compulsive behaviour, which is driven by anxiety. If it is causing an intrusion into day to day life, a doctor or therapist would be able to guide you on the steps to take. If it is driven by anxiety (and again and doctor or therapist will be able to guide you), managing the anxiety will make a difference.

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Jody

My son has rubbed my hair and or his since toddlerhood. I notice it more if he is sleepy. He also does this while he’s asleep. He is now 7 and I just noticed he has a bald spot on the top of his head.
I once had read an article long ago that had this behavior as a symptom of another illness. I can’t seem to find the article or one such since.

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Clara

I have been having this problem since my teenage years. God knows I tried everything to stop the pulling but none of them works.

The article mentioned body-focused therapy. Can anyone share more about this? How do I reach these therapists? Thanks!

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Jen

I love seeing these disorders being highlighted. I have dermatillomania, which is related to trichotillomania in both the underlying motivation and effects on the individual suffering from it. It’s still surprising to me they are not considered a very specific subset of OCD, and that very little research is done on them as a whole.

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Karen Young

Yes it’s such important information isn’t it. Hopefully the more we talk about it, the more research we’ll start to see in the area.

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Concerned great uncle

My sis noticed my great niece pulling out her hair. Sis said she looked over at my g. niece and she had a pile of hair on her lap, and she was separating small amounts of hair before she would pull it out.
She said it feels good. I’m very worried about my niece. (Her dad yells at them a lot. He is very selfish. She also has diabetes) what can I do? Please help.

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Karen Young

This may be a symptom of anxiety. Anxiety can drive all sorts of behaviours which are actually as a way to self-soothe or to distract from unwanted, anxious thoughts. This may be why your niece is saying it feels good. Anxiety is very manageable, but it will take time and persistence. If the behaviours are intrusive and getting in the way of your niece’s day to day function (family, friends, school) it might be an idea to speak with a counsellor or psychologist who can give her the support she needs. In the meantime, there are certainly things you can encourage her towards which will help. One of these is mindfulness. Research has shown that mindfulness changes the structure and function of the brain in ways that can protect and strengthen it against anxiety. If your niece is unfamiliar with mindfulness, a great place to start is the free Smiling Mind app, which has mindfulness meditations for children through to adult. It’s also important that your niece understands her anxiety. This article will help https://www.heysigmund.com/anxiety-in-kids/. There are also many other articles on this link https://www.heysigmund.com/?s=anxiety+children. For a proper diagnosis, I would encourage you to speak with a doctor or therapist. I hope your niece is able to find calm for herself soon. She is lucky to have you watching out for her.

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Mary

Although no doctor acknowledged this as a cause, my son suffered from this while having a spinal leak. I think it was either due to the low fluid in his brain, or due to extreme pain. He was unaware of doing it. I think physical causes should be addressed. He never did this before or after the CSF leak. It could also have been a medication side effect. They thought he had psychological issues, but a comprehensive psych exam confirmed he was one of the most stable teens she had examined. Once a doctor understood and repaired the leak, all symptoms were gone.

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Karen Young

Mary thank much for sharing your story. All information adds to our shared experience and moved us closer to understanding what we need to know.

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Dawn

1. Not always in just teens and adults, my son was 7, my neice about 7 and second son 3. They have since managed to control it (mostly).
2. I believe it is a symptom of something else, mostly anxiety of some kind and then the anxiety could be symptom of something else like sensory disorder for example. I doubt it occurs on it’s own.
3. Would be Interested if there was any research showing percentage of symptoms within family members, therefore suggesting it could be genetic.

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Sharon H

Wow, I’m so sorry to hear that such young people do this.

As for me, I know it is stress and anxiety. It can be traced to when we moved here in 2010. But I had been self-mutilating with a razor for about 15 years, so I feel it is just another expression of severe stress.

As for genetics, only my niece (14) cut her wrists superficially. She is the only family member to my knowledge that has done something like this. Maybe one other person besides myself is not enough to call it genetic, but again I don’t know the full history of my relatives.

I think we must remember that animals injure themselves as well while under extreme stress. Birds are the biggest examples of this, as they can pluck their feathers out until they are bald. Dogs can bite and chew their toes. It is of note that this behavior does not occur in the wild, but only in domesticated animals. Entirely stress induced.

Thank you for sharing. I know it is hard for me to write this. No one but my husband knows about the cutting, though obviously the hair pulling and breaking is quite apparent to him.

It pleases me that your children have been able to gain control over this. It seems we adults have a more difficult time, even with help. With children that young, some other mechanism besides anxiety could be at play.

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Nancy

The anxiety may have a physical cause as we found in our family. We found solutions that help through Dianne Craft, “the biology of learning” (www.diannecraft.org), and Trudy Scott, “the antianxiety food solution” (www.antianxietyfoodsolution.com).

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Julia

I started hair pulling and eating at about 12 years old. My teenage years were awful. I was practically bald. Gradually my pulling slowed down but didn’t cease for about 40 years. I’m now 60 and have a full head of hair. I think mine started when I changed schools and didn’t have any friends, and by pulling my hair I had no chance of making friends, it was a vicious circle. I had no medical help or support and was extremely depressed. It became a habit. My hair was growing back but I still continued to pull, but I managed to control it so I looked normal. Never went to a hairdresser. Couldn’t bear to have people behind me and never went outside if it was windy because I glued what hair I had done in place to cover bald areas with tons of hairspray.
I feel fortunate now that those days are over, if I can offer support in any way I will.

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Karen Young

I’m so pleased to hear you found your way through. Thank you for sharing your story. There is something very powerful in ‘me too’.

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Jacalyn

My 13 year old daughter started pulling her hair out about a year and a half ago. She was seeing the school counselor and it was helping. She can’t see that counselor any longer. There are so few counselors that work with children and the ones that do are far beyond what I can afford. I don’t know what to do. I want to help so badly.

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Karen Young

I can hear how distressing this is for you. It is so awful watching our children struggle. You are an incredible source of support for your daughter, and if professional support is out of reach right now, there are things you can do to help her through. Here are some resources that might help. There are articles on this link https://www.heysigmund.com/category/with-kids/anxiety-in-kids-and-teens/ and videos on this link https://www.heysigmund.com/category/with-kids/anxiety-videos-for-kids/. I hope this helps. Love and strength to you and your daughter.

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Laura

My daughter’s trich started at age 11 and while it has continued through age 17 (current), it turned out to be the first noticeable symptom of Lyme disease and co-infections (especially Bartonella). Children’s symptoms are often the more “psychological” type symptoms, but they are not making it up! See this book for a list of symptoms more people in the mental health profession need to know—I wish I’d had it 6 years ago.

When Your Child Has Lyme Disease: A… https://www.amazon.com/dp/0996224300?ref=yo_pop_ma_swf

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Melissa C

Hi Laura,

Did your daughter’s trich subside after treating for Lyme and Bart?

My daughter also has trich and we’re going down the path of testing for Lyme and co-infections.

Thanks,

Melissa

Reply

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Today I spoke with two big groups of secondary school students about managing anxiety. In each talk, as there are in all of my talks with teens, there were questions. Big, open-hearted, thoughtful questions that go right to the heart of it all. 
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Rather than talking to them about what they can’t do (and they’ll probably want to talk about this a lot - that’s what anxiety does), ask them what they can do. It doesn’t matter how small the step is, as long as it’s forward.
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The idea is to gradually and gently expose them to the things that feel frightening. This is the only way to re-teach the amygdala that it’s safe. Let them know you understand it feels scary - they need to know you feel what they feel and that you get it. This will make your belief in them and your refusal to support avoidance more meaningful. Then move them towards brave.
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This can be tough. To move our children towards the things that are causing them distress pushes fiercely against our instincts as a parent - but - supporting avoidance, overprotecting, over-reassuring, the things we do that unintentionally accommodate anxiety over brave behaviour will only feed anxiety and make it more resistant to change. (And as a parent I’ve done all of these things at some time - we’re parents, not perfect, and parental love has a way of drawing us all in to unhelpful behaviours in the name of protecting our kiddos). .
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The point is, moving our children towards brave behaviour can feel awful, but it’s so important. When they focus on the fear and what they can’t do, try, ‘Okay, I know this feels scary. I really do. I also know you can do this. I understand this step feels too big, so what little step can you take towards it? What can you do that is braver than last time?’

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