Do you often pull your hair, or have someone in your family who suffers from the habit? The underlying condition might be a behavioral disorder known as Trichotillomania. Read and know all about the disease, including its possible causes, symptoms, treatment, prognosis and more.

Trichotillomania Definition

It refers to a loss of hair resulting from repeated urges to twist or pull strands of hair until they break off. This is an impulsive control disease and patients are unable to stop the urges that lead to this condition. The disorder causes a thinning of hair in sufferers.

The condition is also referred to as “Compulsive Hair Pulling.”

Trichotillomania ICD9 Code

The ICD9 Code for this disease is 312.39.

Trichotillomania Etymology

The name of this disorder was coined by Francois Henri Hallopeau, a French dermatologist. The term is a fusion of two Greek words “trich” meaning “hair,” “till” standing for “to pull” and “mania” which stands for “frenzy” or “madness.”

Trichotillomania Epidemiology

The disorder may affect as much as 4% of the entire population. The condition is four times likelier to affect women than men. The incidence for the disorder is possibly underestimated as only those present for medical treatment are taken into count.

Trichotillomania Symptoms

The signs and symptoms of this disorder tend to arise before 17 years of age. The hair may come out across the scalp or in circular patches. The condition gives an uneven appearance to the heads of sufferers. Affected individuals may pluck other hairy regions, such as:

  • Trunk
  • Eyelashes
  • Eyebrows

In children, the following symptoms are generally noticed:

  • Denying the pulling of hair
  • Bare patches or diffused loss of hair
  • Uneven appearance of the hair
  • Other self-injurious behaviors
  • Constant pulling, twisting or tugging of hair
  • Re-growth of hair that feels like stubble in the bare regions
  • Sense of pleasure, gratification or relief after the pulling of hair
  • Elevating sense of tension before the act of pulling of hair
  • Bowel obstruction in case of oral consumption of the hair by sufferers

In adults, the symptoms often include:

Pulling out hair on a repeated basis, typically from the eyelashes, eyebrows or scalp (although extraction may occur from any of the regions of the body)

  • Strong urges to pull out hair, followed by sense of relief after extraction of hair
  • Eating or chewing uprooted hair
  • Sparse or missing eyebrows or eyelashes
  • Playing with uprooted hair
  • Rubbing extracted hair across face or lips

The majority of sufferers also experience the following problems:

  • Anxiety
  • Poor self-image
  • Feeling of depression or sadness

Most patients tend to pull their hair in private and usually try to hide the condition from others, even from their close ones.

The pulling of hair is focused and intentional for certain patients. They are aware of their pulling out of hair and may even develop prominent rituals for the act. Some others also unconsciously pull their hair. An individual may both consciously and unconsciously uproot their hair, depending on their mood and the situation. Many such acts are performed during a frustrated or depressed frame of mind. Some rituals or positions may trigger the act, such as brushing hair or resting the head on the hands.

Trichotillomania Causes

This is a form of impulse control disease, the causes of which are not understood clearly. The disorder, similar to many complex conditions, possibly arises due to a combination of environmental and genetic factors. Abnormalities in the brain chemicals Dopamine and Serotonin may also play a role in the development of Trichotillomania.

Trichotillomania Risk Factors

The factors that tend to increase susceptibility to this condition include:


The condition generally arises during adolescence, most often between 11 and 13 years of age. Trichotillomania is often a lifelong problem. Kids less than 5 years of age can be susceptible to this disorder. This is generally a mild disease and resolves on its own without treatment.


The condition has been found to affect women more than men. However, this may be due to the fact that females seek medical diagnosis and treatment more than males. During early childhood, both girls and boys are found to be equally affected by this disorder.

Family history

The susceptibility to this disease may be inherited in nature.

Positive reinforcement

Those affected by this disorder often find it gratifying to pull out hair and find a certain amount of relief. Due to this pleasurable sensation, they continue to extract hair to maintain positive emotions associated with the act.

Negative emotions

In many sufferers of this condition, pulling of hair is a way of dealing with uncomfortable or negative feelings like fatigue, anxiety, frustration, stress, loneliness and tension.

Other diseases

Those suffering from this disease may also suffer from other conditions, which include eating disorders, obsessive-compulsive disorders, anxiety and depression. Picking of skin and nail biting have also been related with this condition.

Trichotillomania Diagnosis

Physicians tend to perform a complete evaluation of sufferers to assess the presence of Trichotillomania. This may involve examining the amount of hair lost by patients, ruling out probable causes of hair extraction or hair loss. Patients may be given a questionnaire to fill out which can help doctors understand the possible causes for this behavior. In some cases, doctors may carry out a biopsy of the skin or hair to identify the problem accurately.

Trichotillomania DSM Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) clearly mention the criteria that have to be met for a patient to be confirmed of having this disease. The criteria have been published by the American Psychiatric Association and include:

  • Relief or pleasure while pulling out hair
  • Repeatedly extracting hair, leading to a prominent loss of hair
  • Acute mental distress caused by self-extraction of hair
  • An elevating sense of tension prior to pulling, or when sufferers attempt to resist pulling
  • Loss of hair is not attributed to another dermatological or medical condition

There is some amount of debate about these criteria among doctors and patients of Trichotillomania.

Trichotillomania Treatment

There has been limited research about the treatment of this condition. The current medical approaches include:


Physicians may suggest patients to have an antidepressant, such as Clomipramine (Anafranil).


The disease can be effectively cured with the aid of a type of Psychotherapy known as Habit Reversal Training. This therapy helps patients learn to recognize those situations that can influence their mood and make them susceptible to extract their hair and instead, substitute them with other behaviors like redirecting the hands to other objects to control or divert the urge.

In some cases, Habit Reversal Training may be blended with elements of other types of therapies. Health care providers may use cognitive therapy to help sufferers examine and challenge distorted beliefs associated to the act of pulling of hair.

Acceptance and Commitment Therapy (ACT) helps patients learn to accept their impulses related to hair-pulling and simultaneously teach them ways to avoid acting on their own impulses.

Trichotillomania – Alternative Treatment

The alternative treatment for this disorder may involve:

Relaxation techniques

The impulse to pull out hair may be diverted by practicing relaxation techniques like Progressive Muscle Relaxation.


It may be a successful curative option for this disorder.

Trichotillomania Management and Support

Many patients of this disease report about loneliness to be a problem during the act of hair-pulling. Due to this reason, it may be beneficial for sufferers to join a support-group consisting of Trichotillomania patients who experience the same emotions and can relate to their feelings. Sufferers may consult their doctors or visit – the official website of Trichotillomania Learning Center to know about and come across a support group.

The contact details of Trichotillomania Learning Center have been given below:

Trichotillomania Learning Center, Inc.

207 McPherson Street, Suite H

Santa Cruz, CA 95060-5863

831-457-1004 phone

831-427-5541 fax

Email id: [email protected]

Friends and family members of Trichotillomania patients may also derive benefit from group therapy.

Trichotillomania Prognosis

The form of the condition that develops in children less than 6 years of age may resolve even in the absence of medical treatment. In the majority of sufferers, the pulling of hair ends within a span of a year. In case of others, however, the condition tends to be a life-long problem. But treatment often improves the condition and resolves the feelings of anxiety, depression and poor self-image in patients.

Trichotillomania Complications

Although Trichotillomania may not seem to particularly acute in nature, it may have a great effect on the life of its patients. The complications that can be experienced by sufferers include:

Emotional distress

Many sufferers of this disease report about distressful emotions such as humiliation, shame, anxiety, depression, low-self esteem and embarrassment due to this act.

Social difficulties

Due to feelings of embarrassment associated with this disorder, patients may avoid haircuts, windy weather and activities such as swimming. Patients may also style their hair or wear wigs in order to disguise the bald patches on their body. Those prone to picking hair may also wear false eyelashes. Some sufferers may also avoid physical intimacy for fear of the condition being discovered by their sufferers.

Skin damage

Continuous pulling of hair can lead to abrasions and other types of skin damage, which involve infections to the scalp skin or the particular region from which hair has been extracted.


Consumption of uprooted hair may cause the development of a sizeable, matted hairball in the digestive tract of patients. Such hairballs are referred to as Trichobezoar. Over a span of several months or years, these types of hairball can result in problems like intestinal obstruction, vomiting, weight loss and even death.

Trichotillomania Prevention

The best form of prevention is early diagnosis, which leads to an early treatment of the disease and removes possibilities of development of associated complications in future. This can lead to an obstruction in the bowel or result in poor nutrition.


If you are suffering from the condition, or have someone in your family affected by it, seek assistance from a primary care provider or dermatologist who may ultimately recommend sufferers to mental healthcare providers. Early diagnosis and treatment can help in an earlier recovery from this embarrassing disorder and full recovery for patients.


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