Overview
Trichotillomania is hair loss caused by compulsive pulling or twisting of the hair until it breaks off.
Alternative Names
Compulsive hair pulling
Causes
Trichotillomania is a type of compulsive behavior. Its causes are not clearly understood.
It may affect as much as 4% of the population. Women are four times more likely to be affected than men.
People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).
Symptoms
Symptoms usually begin before the age of 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.
These symptoms are usually seen in children:
An uneven appearance to the hair
Bare patches or all around (diffuse) loss of hair
Bowel blockage (obstruction) if people eat the hair they pull out
Constant tugging, pulling, or twisting of hair
Denying the hair pulling
Hair regrowth that feels like stubble in the bare spots
Increasing sense of tension before the hair pulling
Other self-injury behaviors
Sense of relief, pleasure, or gratification after the hair pulling
Tests & diagnosis
A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.
Treatment
Experts don't agree on the use of medication for treatment. However ,naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in reducing some symptoms. Behavioral therapy and habit reversal may also be effective.
Prognosis
Typically, trichotillomania is limited to younger children who tend to outgrow the behavior. For most, the hair pulling ends within 12 months. Children who start pulling hair early (before age 6) tend to do better than those who start later.
Complications
People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.
Prevention
Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.
