What is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania (Hair Pulling Disorder). Getty Images

Trichotillomania (trick-o-till-o-may-nee-uh) is a psychiatric disorder which involves the repetitive pulling out of one's own hair. It is conceptualized to belong to a collection of behaviors known as Body Focused Repetitive Behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body. 

Classified among the "Obsessive Compulsive and Related Disorders" in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Trichotillomania is not uncommon, affecting 1% - 3% of the population.

 The DSM-5 diagnostic criteria include:

  • Recurrent hair pulling, resulting in hair loss
  • Repeated attempts to decrease or stop the behavior
  • Clinically significant distress or impairment in social, occupational, or other area of functioning
  • Not due to substance abuse or a medical condition (e.g., dermatological condition)
  • Not better accounted for by another psychiatric disorder

The onset of Trichotillomania typically occurs between 9 and 13 years of age, although hair pulling can begin at any age. At younger ages, males and females tend to pull at more equal ratios, whereas research suggests that females pull much more frequently than males in adulthood. The course of the disorder is considered to be chronic, with symptoms that tend to wax and wane over time. 

There is a great variation of factors that contribute to the causes and maintenance of Trichotillomania. The disorder is considered to be neurobiologically based, with genetic factors likely playing a significant role.

 Although the function of the behavior varies, it is often experienced as self-soothing or assistive in the regulation of emotions. A great deal of time and effort is often dedicated to hiding or covering up hair loss.

The impact of Trichotillomania on one's life can be significant. Physical effects such as pruritus, tissue damage, infection, and repetitive motion injuries are common.

Furthermore, those who ingest the pulled hair or parts thereof may experience gastrointestinal distress or develop a trichobezoar (hair ball in the intestines or stomach) which could lead to gastrointestinal blockage and require surgical removal. Although trichobezoars are rare, they are a serious risk for those who ingest hair. 

Emotional effects of Trichotillomania may be significant. Individuals struggling withTrichotillomania may experience shame and embarrassment, and as a result, may avoid certain social situations, activities, and medical care. Relationships with others may become strained. Those with Trichotillomania are also at an elevated risk for self-isolation and for a co-occurring psychiatric disorder, such as major depressive disorder, excoriation disorder, or an anxiety disorder.

Evidence-based treatment for Trichotillomania includes a specific Cognitive-Behavioral Therapy (CBT) - Habit Reversal Training (HRT). Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) have been demonstrated to be effective supplemental strategies in addition to HRT.

There is no FDA-approved pharmacological treatment for Trichotillomania. Some individuals find antidepressants somewhat helpful (specifically, Selective Serotonin Reuptake Inhibitors [SSRIs]); however, studies supporting their efficacy evidence mixed results. N-Acetyl Cysteine (NAC), a dietary supplement and amino acid that affects glutamate levels in the brain, has shown some promise in decreasing the behavior in adult women.


Read more about the author and her work.


American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5thed. Washington, DC: American Psychiatric Association; 2013:251-4.

Franklin ME, Flessner CA, Woods DW, Keuthen NJ, Piacentini JC, Moore P, et al. The child and adolescent trichotillomania impact project: descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J Dev Behav Pediatr. Dec 2008;29(6):493-500.

Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator in the treatment of trichotillomania. Arch Gen Psychiatry. 2009;66:756–63.

Stemberger, R.M.T., Thomas, A.M., Mansueto, C.S., & Carter, J.G. (2000). Personal toll of trichotillomania: Behavioral and personal sequelae. Journal of Anxiety Disorders.

Trichotillomania Learning Center. (2011). Expert Consensus Treatment Guidelines for Trichotillomania, Skin Picking, and Other Body Focused Repetitive Behaviors.

Continue Reading