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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.

Alternative Names

Trichotillosis; Compulsive hair pulling

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

Your health care provider will examine your skin, hair, and scalp. A piece of tissue may be removed (biopsy) to find 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 (less than 6 years old) may go away without treatment. For most people, 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.

References

Morelli JG. Disorders of the hair. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 654.

Gould CM, Sanders KM. Impulse-control disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, PA: Mosby Elsevier; 2008:chap 23.

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

Updated: 3/10/2014

Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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