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Mental Disorders

Diagnosis: The Signs and Symptoms of Trichotillomania (Hair-Pulling Disorder)

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C. E. Zupanick, Psy.D.

Trichotillomania, also known as hair-pulling disorder, is the recurrent pulling (removal) of one's hair. The disorder is more common in women and often begins during the onset of puberty. People can pull hair from any part of their body, but the most common sites are the scalp, eyebrows, and eyelids. These behaviors are usually performed in private.

upset teen pulling hairPulling episodes vary. Sometimes people with this disorder pull hairs for just a few seconds, several times a day. Other times people may pull hairs for several hours at a time. These episodes do not usually result in pain. Although the disorder is a chronic condition, there may be periods of time when people are asymptomatic.

Hair pulling has many ritualistic qualities. Some people search for a particular texture of hair, such as a curly or rough hair. Others seek out a strong hair with a root to pull. Twirling or rolling hair between fingers is also common. Some people may spend time in the mirror searching for particular hairs. Although many people put the strand of hair between their teeth or bite the root after the hair is pulled, a small percentage (10-30%) of people with trichotillomania ingest the hair. If large amounts of hair are swallowed, it is recommended that medical help be sought, since this can have serious medical consequences.

People who pull are not always aware of their behavior. Sometimes they do it automatically without being aware of what they are doing. Other times they do it in response to particular triggers. These triggers may include certain emotional states such as anxiety, stress, boredom, or overexcitement. Other triggers include an itching sensation, or a feeling of tension, followed by an urge to pull and relief after pulling.

People with this disorder can experience a mix of shame, frustration, and embarrassment due to the noticeable hair loss. Since it is not a well-known condition, many people struggle with secrecy as well. Due to embarrassment over hair loss, certain activities may be avoided, such as swimming, exercising, or going to medical checkups. They may even miss work and school because of feeling embarrassed or ashamed about their hair loss.