Impulse Control Disorders Trichotillomania

Sometimes “pulling out your hair” is more than just a turn of phrase. In fact, hair pulling can disrupt lives and cause serious emotional distress. A compulsive urge to keep pulling out hair is called trichotillomania disorder.

Trichotillomania is an impulse control disorder characterized by compulsive hair pulling. Individuals find themselves pulling out hair from their scalp as well as other sites — such as eyelashes, eyebrows or pubic area.

People with trichotillomania can be either very ritualistic about hair pulling or practically unaware that they’re pulling out hair.

The hair pulling can get so extreme that people with the disorder develop patchy bald areas and spend significant time and money trying to cover them up. They may become socially isolated as a result of the shame and fear they feel due to their trichotillomania.

After pulling out hair, some people with trichotillomania eat the hair, which can cause hairballs and significant medical issues, such as gastrointestinal obstruction.

Characteristics of Trichotillomania Disorder

According to the Encyclopedia of Mental Disorders, trichotillomania affects 1 to 4 percent of the general population. Although both males and females get trichotillomania, hair pulling is more common in women.

People with trichotillomania generally start pulling out hair between ages 11 and 13. Because it involves compulsion and repetitive behavior, trichotillomania is often linked with obsessive-compulsive disorder (OCD). Pulling out hair has also been connected to depression and anxiety. Mutations in the SLITRK1 gene have been linked to trichotillomania and Tourette’s Syndrome.

Environmental and stress factors tend to cause or exacerbate trichotillomania. Some young people engage in hair pulling in response to a traumatic event such as abuse or the death of a parent.

Diagnosing Trichotillomania Disorder

According to the Encyclopedia of Mental Disorders, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists these criteria for a trichotillomania disorder diagnosis:

  • An irresistible, recurrent impulse for pulling out hair
  • A buildup of tension before hair pulling
  • A sense of relief after pulling out hair
  • The lack of any other mental or medical disorders that accounts for hair pulling
  • Noticeable hair loss due to hair pulling
  • Significant distress and harm to personal and professional life due to hair pulling.

Treatment for Trichotillomania

A number of treatment methodologies are available for people with trichotillomania, including:

  • Behavioral therapy, including cognitive behavior therapy that promotes habit changes through awareness and acceptance commitment therapy that teaches techniques to avoid acting on impulses, have been effective with trichotillomania disorder
  • Antidepressants with serotonergic properties like Clomipramine have been more effective than the selective serotonin reuptake inhibitors (SSRIs). Medication seems most effective when combined with behavioral therapy.
  • Alternative therapies such as hypnosis and biofeedback have been helpful for some trichotillomania patients
  • Support groups can provide people with hair pulling problems the understanding, inspiration and practical advice they need.


Encyclopedia of Mental Disorders. (2010). Trichotillomania. Retrieved July 16, 2010, from

Hucker, S. J. (2005). Trichotillomania. Retrieved July 14, 2010, from

Mayo Foundation for Medical Education and Research. (2009). Trichotillomania. Retrieved July 14, 2010, from

Mental Health America. (2010). Fact sheet: trichotillomania. Retrieved July 14, 2010, from

Trichotillomania Learning Center, Inc. (2007). About trichotillomania. Retrieved July 14, 2010, from