Trichotillomania – Hair Pulling Anxiety OCD Disorders: Causes & Treatments


Trichotillomania is the therapeutic term of the hair-pulling disorder, which triggers the compulsive urge to pull his or her own hair. Trichotillomania is a mental disorder that causes an irresistible urge of pulling hair from the scalp, eyebrows and other areas of the body, despite stoping it grow.

The hair-pulling disorder is the form of obsessive-compulsive disorder.

In India, there are 1 million cases per year that get reported.

It can cause further distress to the person resulting in a decrease in social and occupational functioning.

What are the causes of trichotillomania or hair-pulling disorder?

Till now there has been no reason found out about why trichotillomania occurs. But on the biological level, it has been propounded by medical experts that it is due to some disturbances and disruption in the chemical messenger nerve cells of the brain. There are other factors that  also include:

  • Taking excessive stress and anxiety
  • Genetic predisposition
  • Or other medical problems

The exact cause or reason behind this mental disorder must be examined by the doctor as soon as one starts to exhibit changes.

It has been believed that this mental disorder usually occurs at the age of adolescence. This is the essential time for teens as they grow mentally and physically.

 Many different changes occur in their emotional and physical state, they develop their self-esteem, body image, sexuality and relationships with their peers. There are many related factors and social discomfort that arise with these mental disorders which can give a lasting impact on the mind of an adolescent.

Any social conflict or family conflict or abuse or any deaths can trigger the mental disorder trichotillomania in the mind of people.

This disorder is often associated with hair pulling anxiety disorder, where the person is restlessly in anxiety.

The person with trichotillomania may have disorders like anxiety, depression or obsessive-compulsive disorder(OCD).

What are the symptoms of hair-pulling disorder?

Trichotillomania is a spectrum of Obsessive-compulsive Disorder, hence it means that the symptoms of hair pulling would relate to the symptoms of OCD. Some of the underlying symptoms are :

  • The repeated actions of pulling the hair from the body
  • An increase of tension prior to hair pulling and trying to resist the action but not able to.
  • The feeling of shame and embarrassment due to loss of hair   which leads in avoidance of work, school, college 
  • A feeling of relief after scraping off the hair
  • There is a noticeable amount of hair loss
  • Playing with scraped off hair or rubbing it across the face
  • The action of chewing, biting or eating the pulled hair 
  • There are also some people who bite their nails and lips as a result of their illness
  • The act of hair-pulling by the affected person is done in private places

The hair-pulling is preceded by anxiety, tension, stress and ends in gratification, relaxed mental state once the hair is pulled off. 

There are also cases where the person is pulling of the hair while watching TV, or doing any mindless activities just because he/she is being bored.

What is hair -pulling treatments?

The hair-pulling disorder is self- diagnosable mental illness but with proper treatment and medications it can be cured quickly.

Researchers have found out that the correct solution to cure Trichotillomania is behavioral therapy, including habit reversal training.

Habit reversal training involves four steps which include 

  • Self- awareness training, which will help the individual to know the disorder
  • Self-relaxation training, which helps the individual to practice muscle relaxation techniques
  • Diaphragmatic breathing, which will help the individual to learn to breathe in relaxation skills
  • Competent response training, which will help the individual to practice muscle tension skills which compete with their hair-pulling behavior

Trichotillomania is a complex disorder and the clinicians have claimed that along with Habit reversal training, cognitive behavioral therapy (CBT), dialectical behavioral therapy (DPT) and acceptance commitment therapy(ACT) is also important to treat the individual for the best results.

Apart from effective therapies, there are certain medications that can affect temporary symptoms of the disorder. It can be effective in reducing depression and obsessive-compulsive symptoms.

Common Medicines that can be used :

  • Fluoxetine
  • Valproate
  • Lithium carbonate
  • clomipramine
  • sertraline 

Major complications on Individuals with mental illness of Trichotillomania

  • People experience a state of extensive harassment and humiliation, which make it develop low esteem, anxiety in them.
  • Some people fear intimacy due to the fright that their illness might get discovered.
  • The people who constantly pull their hair can cause scarring in their faces and other damage. It can also cause other infections in the area where the hair is being pulled off.
  • The disorder involves one of the symptoms of eating the pulled hair, the action can cause a large and matted hairball(trichobezoar) in the digestive tract. This accumulation of hair in the digestive tract will cause vomiting, intestinal infections, and obstructions and then most of the cases it leads to deaths.

Trichotillomania is more common with women adults than men adults. 

The child pulling hair out caused due to trichotillomania is rare disorder among children but common in adolescents in the age of between 13-16 year. Children too feel the strong urge of pulling out hair whichever areas they see in their bodies.

It is often advised to keep sharp things far away from children.

Trichotillomania is a body-focused continuous behavior of hair-pulling just like any other obsessive-compulsive disorder – Kleptomania, pathologic gambling, pyromania. It comes with catastrophic complications on the emotional and physical state of the individual.

It must be treated as soon as one starts to show the extensive pervasive behavior of pulling out hair.


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