Compulsive Hair Pulling - An Impulse Control Disorder

Woman pulling strand of hair
Getty Images/ZenShui/Michele Constantini/PhotoAlto Agency RF Collections

Trichotillomania (trik-o-til-o-MAY-nee-uh), also known as Trichotillosis or compulsive hair pulling, is an impulse control order (ICD) that presents as a strong urge to pull or twist out your own hair. The hair can be on various parts of your body, including the scalp, face, arms, legs, eyebrows, eyelashes, and pubic areas. More females than males are affected by this disorder.

Trichotillomania, also known as TTM or “trich”, is considered to be part of a family of “body-focused repetitive behaviors” (BFRBs).

Most people with trichotillomania will pull their hair while they are reading, writing, working on the computer, talking on the phone, or watching television.

Causes of Trichotillomania

The cause of trichotillomania is essentially unknown. It is thought to be a neuro-biological disorder that may have a genetic or environmental connection. It is thought that people with trichotillomania pull their hair as a coping mechanism for stress.

Signs and Symptoms of Trichotillomania

Symptoms of trichotillomania may begin in children less than six years of age but it usually develops during the late teenage years. Most people with this disorder are affected with depression, anxiety, and poor self-image.

Some signs and symptoms may include the following:

  • Recurrent hair pulling that results in noticeable hair loss
  • Bowel obstruction
  • Denial of hair pulling
  • Self-injury behavior
  • Pleasure, excitement or relief when the hair is pulled
  • Embarrassment or shame from the hair loss
  • Wearing hats, wigs, or scarves
  • Excessive touching of hair
  • Problems at work, home, or school

About 10 percent of patients with trichotillomania eat their hair after they have pulled it out, this condition, known as trichophagia, can result in the development of a large hairball in the digestive tract.

Over time, it can cause weight loss, vomiting, severe gastrointestinal blockage, and death.

Treatment of Trichotillomania

Without treatment, trichotillomania can be a chronic condition or it can be a temporary problem that begins and ends without treatment. Early detection of trichotillomania can lead to early treatment. A reduction in stress levels will help reduce the compulsive behavior pattern.

Other methods of treatment include:

  • Cognitive behavioral therapy (CBT) will help the patient become aware of situations and events that causes episodes of hair-pulling. Techniques may include habit reversal training, biofeedback and hypnosis.
  • Medication therapy to reduce levels of anxiety, depression and obsessive compulsive behavior symptoms.
  • Family therapy and support groups.

Treatment options will vary based on the needs of the patient and their family.


  • MedlinePlus
  • TLC – Trichotillomania Learning Center
  • American Academy of Child & Adolescent Psychiatry
  • The Nemours Foundation
  • Mental Health America
  • Mayo Clinic

Continue Reading