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

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

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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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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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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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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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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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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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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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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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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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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.

Reply

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We teach our kids to respect adults and other children, and they should – respect is an important part of growing up to be a pretty great human. There’s something else though that’s even more important – teaching them to respect themselves first. 

We can’t stop difficult people coming into their lives. They might be teachers, coaches, peers, and eventually, colleagues, or perhaps people connected to the people who love them. What we can do though is give our kids independence of mind and permission to recognise that person and their behaviour as unacceptable to them. We can teach our kids that being kind and respectful doesn’t necessarily mean accepting someone’s behaviour, beliefs or influence. 

The kindness and respect we teach our children to show to others should never be used against them by those broken others who might do harm. We have to recognise as adults that the words and attitudes directed to our children can be just as damaging as anything physical. 

If the behaviour is from an adult, it’s up to us to guard our child’s safe space in the world even harder. That might be by withdrawing support for the adult, using our own voice with the adult to elevate our child’s, asking our child what they need and how we can help, helping them find their voice, withdrawing them from the environment. 

Of course there will be times our children do or say things that aren’t okay, but this never makes it okay for any adult in your child’s life to treat them in a way that leads them to feeling ‘less than’.

Sometimes the difficult person will be a peer. There is no ‘one certain way’ to deal with this. Sometimes it will involve mediation, role playing responses, clarifying the other child’s behaviour, asking for support from other adults in the environment, or letting go of the friendship.

Learning that it’s okay to let go of relationships is such an important part of full living. Too often we hold on to people who don’t deserve us. Not everyone who comes into our lives is meant to stay and if we can help our children start to think about this when they’re young, they’ll be so much more empowered and deliberate in their relationships when they’re older.♥️
When we are angry, there will always be another emotion underneath it. It is this way for all of us. 

Anger itself is a valid emotion so it’s important not to dismiss it. Emotion is e-motion - energy in motion. It has to find a way out, which is why telling an angry child to calm down or to keep their bodies still will only make things worse for them. They might comply, but their bodies will still be in a state of distress. 

Often, beneath an angry child is an anxious one needing our help. It’s the ‘fight’ part of the fight or flight response. As with all emotions, anger has a job to do - to help us to safety through movement, or to recruit support, or to give us the physical resources to meet a need or to change something that needs changing. It doesn’t mean it does the job well, because an angry brain means the feeling brain has the baton, while the thinking brain sits out for a while. What it means is that there is a valid need there and this young person is doing their very best to meet it, given their available resources in the moment or their developmental stage. 

Children need the same thing we all need when we’re feeling fierce - to be seen,  heard, and supported; to find a way to get the energy out, either with words or movement. Not to be shut down or ‘fixed’. 

Our job isn’t to stop their anger, but to help them find ways to feel it and express it in ways that don’t do damage. This will take lots of experience, and lots of time - and that’s okay.♥️
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There are many things that can send a nervous system into distress. These can include physiological (tired, hungry, unwell), sensory overload/ underload, real or perceived threat (anxiety), stressed resources (having to share, pay attention, learn new things, putting a lid on what they really think or want - the things that can send any of us to the end of ourselves).

Most of the time it’s developmental - the grown up brain is being built and still has a way to go. Like all beautiful, strong, important things, brains take time to build. The part of the brain that has a heavy hand in regulation launches into its big developmental window when kids are about 6 years old. It won’t be fully done developing until mid-late 20s. This is a great thing - it means we have a wide window of influence, and there is no hurry.

Like any building work, on the way to completion things will get messy sometimes - and that’s okay. It’s not a reflection of your young one and it’s not a reflection of your parenting. It’s a reflection of a brain in the midst of a build. It’s wondrous and fascinating and frustrating and maddening - it’s all the things.

The messy times are part of their development, not glitches in it. They are how it’s meant to be. They are important opportunities for us to influence their growth. It’s just how it happens. We have to be careful not to judge our children or ourselves because of these messy times, or let the judgement of others fill the space where love, curiosity, and gentle guidance should be. For sure, some days this will be easy, and some days it will feel harder - like splitting an atom with an axe kind of hard.

Their growth will always be best nurtured in the calm, loving space beside us. It won’t happen through punishment, ever. Consequences have a place if they make sense and are delivered in a way that doesn’t shame or separate them from us, either physically or emotionally. The best ‘consequence’ is the conversation with you in a space that is held by your warm loving strong presence, in a way that makes it safe for both of you to be curious, explore options, and understand what happened.♥️
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