Trichotillomania

Daria used to make up excuses for the bald spot on the back of her head, like saying the baseball caps she had to wear at her job were too tight. She knew people doubted her stories, especially family members. But she couldn't face telling them what was really happening: She'd been pulling her hair out since she was 12.

Daria had no idea why she pulled her hair. She just knew that she couldn't stop. 

What Is Trichotillomania?

Trichotillomania (pronounced: trik-oh-till-oh-MAY-nee-uh) is a condition that gives some people strong urges to pull out their own hair. It can affect people of any age.

People with trichotillomania pull hair out at the root from places like the scalp, eyebrows, eyelashes, or pubic area.

Some people with the condition pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows. Other people pull out their hair one strand at a time. They might inspect or play with the strand after pulling it out. About half of people with trichotillomania put the hair in their mouths after pulling it.

Some people are very aware of their pulling. Others seem to do it in a very absent-minded way, without really noticing what they're doing.

For people with trichotillomania, resisting the urge to pull out their hair feels as hard as resisting the urge to scratch a very itchy itch. 

Some people say that the urge to pull starts with a feeling in their scalp or skin, like an itch or a tingle. Pulling the hair seems like the only way to get relief. People might have a brief feeling of satisfaction for a moment after pulling out their hair.

People with trichotillomania may feel embarrassed, frustrated, ashamed, or depressed about it. They may worry what others will think or say. They might feel nagged by people who don't understand that they're not doing this on purpose. 

People with trichotillomania usually try to hide the behavior from others — even their families. This can make it difficult to get help.

Having trichotillomania can affect how people feel about themselves. Some are self-conscious about how hair pulling affects their appearance. They might feel less confident about making friends or dating. Others can feel powerless to control the urge to pull or blame themselves for not being able to stop.

What Causes Trichotillomania?

No one knows exactly why some people develop trichotillomania. Stress may play a part. So might a person's genes. People who have other compulsive habits or OCD may be more likely to develop trichotillomania.

Experts think the urge to pull hair happens because the brain's chemical signals (called neurotransmitters) don't work properly. This creates the irresistible urges that lead people to pull their hair. 

Pulling the hair gives the person a feeling of relief or satisfaction. The more the person gives in to the urge by pulling and has the brief feeling of relief afterwards, the stronger the habit becomes. The longer this continues, the harder it is to resist the urge when it happens again. 

How Do People Overcome It?

People with trichotillomania usually need help from medical and behavioral specialists in order to stop. With the right help, most people overcome their hair-pulling urges. When someone is able to stop pulling, hair usually grows back.

Overcoming hair-pulling urges may involve a type of behavioral therapy called habit substitution, taking medicine, or a combination of therapy and medicine.

In therapy, people with trichotillomania learn about urges. They learn how urges fade on their own when people don't give in to them, and how urges get stronger and happen more often when people do give in. They learn to identify situations, places, or times they usually have an urge to pull. 

Therapists teach people with trichotillomania how to plan a replacement habit they can do when they feel a strong urge to pull hair. Replacement habits might be things like squeezing a stress ball, handling textured objects, or drawing. The therapist guides the person on how to use the new habit to resist the urge to pull hair. With practice, a person gets better at resisting the urge to pull. The urge becomes weaker and easier to resist. 

Because the urges and habits that lead to hair pulling are so strong, resisting can be difficult at first. People may feel more tension or anxiety as they begin to resist urges to pull. A therapist can coach a person through these difficult parts and offer support and practical advice about how to reverse the powerful urges.

Sometimes medicines can help the brain deal better with urges, making them easier to resist. A therapist may also help people with trichotillomania learn to manage stress, deal with perfectionism, or work out other compulsive habits they may have, like nail biting. 

If you're worried about hair pulling, talk to a parent, school counselor, or someone you trust about getting help overcoming the problem.