Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 18, 2016

Trichotillomania can severely disrupt the lives of sufferers. It presents as a desire to pull one's hair out of the scalp, facial areas, and other body parts excessively, resulting in noticeable absence of hair. While it can feel like a lonely battle, it should be known that there are many others who are fighting to win.


Definition & Facts

Trichotillomania is defined as a condition associated with a type of obsessive-compulsive disorder. About 1% of the population is known to be affected by trichotillomania, but the number is thought to be higher, due to under-reporting and poor understanding of the condition.

Symptoms may first appear around 10 years of age, and often peak during adolescence. Trichotillomania affects females at a rate of around 3 cases for every 1 male. For some, the activity peaks, and then fades as quickly as it began. However, for some, it becomes a lifelong battle.

It is suggested that up to 60% of adults with trichotillomania also suffer from a separate psychological condition as well. Patients who begin controlling their symptoms earlier in life do better overall than those who wait to seek treatment. Adults who carry symptoms from childhood and who delay seeking medical attention longest often have less favorable outcomes.

Symptoms & Complaints

A clear symptom of trichotillomania is the discovery of bald patches on the body which cannot be explained by a known medical issue. If someone goes out of their way to hide hair, whether behind unneeded sunglasses, with scarves, or a use of wigs, and these behaviors are out of character, it makes sense to consider the possibility that trichotillomania may play a role.

The person may also have experienced sudden emotional loss, such as a professional upset or a relationship failure. Typically, other signs may include the sufferer appearing anxious or acting sad. In children, activities that once were enjoyed are avoided, and the child may withdraw from social interaction. Noticing changes in personality are often key to discovering the seriousness of trichotillomania.


While theories abound regarding the origin of the trichotillomania, no root cause is known. There is a strong suggestion that genetics play a role in developing the disorder. Likewise, it's been thought that there may not be a singular cause, but many, just as is the case of diseases like cancer or heart disease. Research is ongoing with the belief that one day a clear cause will be discovered, and a known cure will be developed. Until then, sufferers need not suffer in silence. Though the cause is yet to be determined, what is known is that the act of pulling out one's hair is often triggered by common psychological themes, which include situations of high anxiety and nervous stress.

Diagnosis & Tests

The first step in diagnosing trichotillomania is through an evaluation by a qualified health care professional. This includes presenting all signs and symptoms for a medical consultation. Perhaps a family physician can refer the patient to a mental health counselor, as the majority of cases are handled by those trained to provide care in mental disorders.

Testing and diagnoses include several factors. The degree of hair loss will be evaluated, and the sufferer will most likely be asked to complete questionnaires to better understand the patient's individual lifestyle and situation. There will also likely be a series of medical exams and testing performed to rule out the possibility of other disease within the body. These tests could include blood tests and examination of the scalp and hair follicles.

Treatment & Therapy

Once a diagnosis is rendered, there are a variety of options for treatment intended to control trichotillomania's influence on the patient's life. First, a recommendation of behavior therapy is the most common suggestion offered. This comprehensive therapy assists the patient in recognizing situations in which he or she experiences the “trigger” to pull out their hair. Cognitive behavior therapy teaches more appropriate behavior for the person to engage in.

While no one drug is approved specifically to treat trichotillomania, several can potentially offer hope by reducing the stress and anxiety which often lead the sufferer to experience the urge to pull hair out. They include daily medications, such as selective serotonin reuptake inhibitors (SSRIs), as well as other prescription antidepressants and mood stabilizers.

Another option is a prescription medication that can be taken on an “as needed” basis. This may include medication to reduce anxiety, such as a benzodiazepine. Other offerings may be medicine to help induce restorative sleep, or an antihistamine to inhibit itching and discomfort in areas affected by hair pulling. Lastly, if sensations within the skin appear to trigger hair pulling in an individual, the patient may be given a topical medication, such as an anesthetic cream or topical steroid lotion, reducing those sensations and decreasing the likelihood of hair pulling in those areas.

In many instances, it can be extremely helpful for those who suffer from trichotillomania to join a support group of others like themselves. Feeling alone is a hallmark of such a condition, and knowing that is not the case can make a huge difference for anyone seeking a life not ruled by secrecy and shame.

Prevention & Prophylaxis

While there is currently no known method to prevent trichotillomania, intervention in the earliest phase of the disorder can limit the degree of potential damage caused by the condition. Seeking treatment at the first appearance of symptoms can help control the stress that often precedes episodes of hair pulling.

Managing stress and anxiety is the closest to prevention or cure available. Anyone who believes they may be affected by trichotillomania should seek out medical advice quickly. By doing so they can maintain control of their own lives before trichotillomania steals their ability to enjoy living. It is always a good idea to implement a healthy lifestyle when faced with any condition capable of disrupting daily life. Feeling physically healthy by eating a healthy diet and participating in regular exercise is an important step towards becoming mentally healthy, enabling a patient to focus on overall healing and recovery.