Pulling hair habit

Trichotillomania (hair pulling disorder) - NHS

Trichotillomania, also known as trich, is when someone cannot resist the urge to pull out their hair.

They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes.

Trich is more common in teenagers and young adults.

Symptoms of trichotillomania

People with trich feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief.

A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it.

Most people with trich pull out hair from their scalp, but some pull out hair from other areas, such as their:

eyebrows
eyelashes
genital area
beard or moustache

Bald patches on the head may have an unusual shape and affect 1 side of the head more than the other.

Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

Causes of trichotillomania

It's not entirely clear what causes trich. It could be:

your way of dealing with stress or anxiety
a chemical imbalance in the brain, similar to obsessive compulsive disorder (OCD)
changes in hormone levels during puberty

For some people, hair pulling can be a type of addiction. The more they pull their hair out, the more they want to keep doing it.

When to see a GP

See your GP if you're pulling your hair out or if you notice that your child is.

You should also see your GP if you or your child has a habit of eating hair. This can cause hairballs to form in the stomach, leading to serious illness.

Your GP may examine areas where the hair is missing to check that nothing else is causing the hair to come out, such as a skin infection.

If your GP thinks you have trich, you may be referred for a type of treatment called cognitive behavioural therapy (CBT).

Treating trichotillomania

Trich is commonly treated using a type of CBT called habit reversal training.

This aims to help you replace a bad habit with something that's not harmful. Treatment usually involves:

keeping a diary of your hair pulling
working out the triggers for your hair pulling and learning how to avoid them
replacing hair pulling with another action, like squeezing a stress ball

loved ones providing emotional support and encouragement

Antidepressants are not are not usually prescribed to treat trich.

Things you can try yourself

Here are some tips from people with trich that may help when you feel the urge to pull your hair:

squeeze a stress ball or something similar
form a ball with your fist and tighten the muscles in that arm
use a fidget toy
wear a bandana or a tight fitting hat, such as a beanie
come up with a saying that you repeat out loud until the urge to pull passes
take a soothing bath to ease any stress or anxiety
practise deep breathing until the urge to pull goes away
exercise
put plasters on your fingertips
cut your hair short

Getting support

It may also help to open up about your trich to people you trust, as hiding it can sometimes make your anxiety worse.

Many people who have learned to manage their trich say that speaking to others about the condition led to a reduction in hair pulling.

The charity Trichotillomania Support has information on treatments and self-help advice.

Page last reviewed: 29 January 2021
Next review due: 29 January 2024

Trichotillomania (Hair Pulling) (for Teens)

Trichotillomania is a strong habit that causes people to pull out their own hair. They may pull hairs from their scalp, eyebrows, eyelashes, or pubic area. People may pull out a few hairs at once or one strand at a time. Some may look at, play with, chew, or eat the hair after pulling it out.

Others may not understand why people who pull out their hair don’t just stop. But to people going through this, hair pulling can be a very hard habit to break. Even though they have tried to stop, hair pulling can feel impossible to control.

If you are dealing with hair pulling, you’re not alone. And there’s treatment that can help. It takes time, patience, and practice. But when they learn the right skills, people can overcome hair pulling.

What Is Trichotillomania (Hair Pulling)?

Trichotillomania is sometimes called TTM. It is also called tric or hair pulling.

Hair pulling is a type of body-focused repetitive behavior (BFRB for short). BFRBs are self-grooming behaviors that become strong, unwanted habits.

There are different forms of BFRBs. For example, some people bite or chew their nails, lips, or the inside of their cheeks. Some pick their skin or nails. Some pull out, break off, twist off, or chew their hair. All these habits are BFRBs if a person does them to extreme.

BFRBs are not a type of self-harm. But they can cause damage to the hair, skin, or nails.

Can Trichotillomania Cause Health Problems?

Hair pulling can leave bald patches or areas without hair, eyebrows, or eyelashes. It can cause the skin to become sore or infected. It can leave scars. If people chew or swallow hair, it can cause a ‘ball’ of hair to form. This can lead to stomach pain or other health problems.

What Causes Trichotillomania (Hair Pulling)?

It’s not clear why some people do hair pulling but others don’t. Experts think that genes, hormones, and habit learning all play a role.

Genes. People who do hair pulling may have genes that make it more likely.

Hormones. Puberty hormones and stress hormones may prompt hair pulling to start in those who have the genes for it.

Habit learning. Many people with trichotillomania feel an itch, tingling, or an urge to do it. When they pull hair, they get a brief sense of relief. To the brain, this relief is a reward. The brain releases a reward hormone called dopamine. This links hair pulling with the reward. It causes a hair-pulling habit to form.

Each time the person pulls hair, the brain releases a small burst of dopamine. The person feels ‘rewarded’ with a brief feeling of relief. This makes the urge harder to resist. Doing the habit makes it stronger.

What’s It Like for Someone With Trichotillomania?

Most people who do hair pulling feel stuck in a habit they don’t want. They may feel frustrated that they can’t control it. They may feel nagged by people who don't understand what it’s like for them. Some are hard on themselves for not being able to stop. But hair pulling is not their fault.

They may feel upset about how hair pulling affects their looks. Some may try to cover bald patches with hats or make up. Hair pulling can affect the way they feel around others, too. Some try to hide the hair pulling, even from family or friends. They might avoid doing things that could let others notice it.

Can People Overcome Trichotillomania (Hair Pulling)?

A type of therapy called habit-reversal training (HRT) can help people who are dealing with hair pulling. It is a type of cognitive behavioral therapy (CBT). In this therapy, people meet with a therapist to learn skills to help them reverse the hair pulling habit. With time, patience, and practice, people can overcome hair pulling.

How Does Therapy for Trichotillomania Work?

Habit reversal is based on the way the brain learns habits. The same principles can help people unlearn a habit they don’t want.

To unlearn hair pulling, people need to resist the urge to pull hair. When they resist the urge, the reward hormone doesn’t get released. This breaks the cycle of hair pulling. Without the reward, the habit can start to fade on its own.

This sounds simple. But it’s not easy at first. The urge to pull hair can feel strong. It can be very hard to resist. Therapy is a way for people to build the skills that make it possible. With the right guidance — and plenty of practice — it gets easier. For this to work, people need to resist the urge to pull every time they feel it.

Therapy might also include skills like mindfulness, managing emotions, self-talk, and self-compassion. These skills can be helpful to people as they learn to do habit reversal.

What Should I Do if I’m Dealing With Trichotillomania?

Talk to an adult. If you're pulling your hair, talk about it with a parent, doctor, mental health counselor, or an adult you trust. It can be hard to talk about. But it’s best to be open and honest so that you can get the help you need.

Have a visit with your doctor. They will ask questions, listen, and talk with you and your parent. They will check for other things that can cause hair pulling or hair loss. If they diagnose trichotillomania, they can refer you to a therapist for treatment that can help.

Go to visits with a therapist. Therapy can take many visits. It takes time and practice to get good at the skills you’ll need. But you’ll notice progress along the way.

Let others support you. Support from loved ones helps a lot when you’re going through something like hair pulling. When you want to, it can feel good to confide in someone you trust. You can also feel their support when they do simple acts that show they care — or just by spending time together.

Do things to manage your stress. Stress doesn’t cause hair pulling. But stress can make it worse in people who have it. Be sure to eat foods that are good for you. Exercise and be active. Take time to rest, relax, or meditate. Make time for things you enjoy. Show kindness and help others. Doing these simple things every day helps keep stress levels in check.

The TLC Foundation for Body-Focused Repetitive Behaviors is a good resource for learning more as well as getting help and support.

Reviewed by: D'Arcy Lyness, PhD

Date reviewed: November 2022

The child pulls his hair. What to do?

Hair pulling is a common habit among children. In most situations, it is quite harmless, but in some cases it requires special control.

Why does the child pull his hair?

The following are some of the reasons why a child may pull their hair.

Self-calming mechanism

The child may pull his hair to calm himself down in situations that he considers stressful or when he wants to calm himself for no particular reason.

You may notice that your baby is pulling his hair when he is worried about the upcoming separation.

Self-soothing hair pulling may be accompanied by other self-soothing activities such as thumb sucking.

Experimentation

Children over six months old may pull their hair to experiment with cause and effect; to see how the hair reacts to being pulled, or how the parents react to the action.

Self-awareness

Babies become aware of their bodies as they grow older, and this awareness increases significantly between the ages of eight and 12 months. An infant at this age can explore various parts of the body such as the nose, toes, and even hair.

The child may repeatedly pull his hair and may do so in situations where he becomes more self-aware, such as looking at himself in a mirror.

Habit

The child may pull his hair out of habit without a noticeable trigger. Some children may have a habit of only pulling their hair in certain places, such as kindergarten or a park. This may be their way of providing themselves with self-stimulation, as it makes them feel good.

Disappointment and hysteria

Some older children and toddlers may pull their hair out of frustration or temper tantrums. Most likely, the action will be accompanied by other signs of hysteria, such as screaming and screaming.

A child may pull his hair in front of a parent or caregiver to express his annoyance.

Toddlers who pull their hair out of tantrums can usually also pull someone else's hair.

Trichotillomania

This is usually the only major cause of hair pulling in children. Trichotillomania is a type of compulsive disorder in which a person may experience a recurring urge to pull their hair. It is a mental disorder similar to obsessive-compulsive disorder and can also affect very young children.

It is not known what causes trichotillomania, but genetic and environmental factors may play a role.

When should I see a doctor?

Hair-pulling behavior in children is not usually a cause for concern. However, you may want to consult your doctor in the following scenarios.

Child pulls hair to such an extent that it causes bleeding
You notice bald spots on the scalp
Pulling the hair is always accompanied by colic
Child also pulls eyelashes and eyebrows

How can I prevent my child from pulling his hair?

Below are various ways to discourage your child from pulling their hair.

Provide alternatives for complacency

Most children tend to pull their hair to calm themselves. You can provide them with alternatives to keep them from reaching for their hair whenever they need to comfort themselves. Blankets are a great option.

You can also use toys, swaddling and even white noise to calm your baby when they seem stressed.

Refer to triggers

Does the child pull her hair before going to bed? Most likely, the baby is tired and thus trying to calm himself.

You can try to identify possible triggers for hair pulling behavior and address them accordingly.

Distract the child

This works great when the child pulls the hair without much trigger, but in certain places. For example, if your toddler has a habit of pulling his hair while walking outdoors, provide him with a toy to keep him busy.

You can also keep a close eye on their actions to distract them before they pull their hair.

Some other ways to distract the child are talking, singing, pointing to interesting objects or games.

Use simple words to discourage the child

Use a specific word or phrase when the child starts to pull his hair. You can say "No" or "Don't do this" to express your disapproval of this behavior.

Set rules and reinforce positive behavior

Older children and toddlers can be discouraged from pulling their hair with rules. For example, set a rule that the moment your baby wants to pull his hair, he will turn to you or to the nearest caregiver. You can also teach them how to get out of a situation when they feel like pulling their hair.

Trichotillomania therapy

The diagnosis of trichotillomania may take time as the doctor may re-evaluate the child at an older age to conclude that the disorder is present.

If a child is diagnosed with trichotillomania, they may need cognitive behavioral therapy to control the urge to pull their hair.

Frequently Asked Questions

1. Is hair pulling a sign of autism?

Hair-pulling behavior may be unusual in people with autism. However, this is not an essential sign of autism.

There are several noticeable early signs of autism, and hair-pulling behavior is not one of them.

2. Can trichotillomania go away?

There is no specific treatment for trichotillomania because its causes are not well understood. However, appropriate therapy and lifestyle changes can help the child deal effectively with the condition, leading to suppression of triggers and, to a lesser extent, a lack of desire to pull hair.

References:

Ruth Golomb, Toddler and Pre-School Hair Pulling; The TLC Foundation
Biting, pinching and hair-pulling; Raising Children Network
Emotional and Social Development: 8 to 12 Months; American Academy of Pediatrics
Challenging Case: Behavioral Changes; American Academy of Pediatrics
Trichotillomania; National Organization for Rare Disorders
Ruziana Masiran, Autism and trichotillomania in an adolescent boy; U. S. National Library of Medicine
Habit Reversal Training; USF Health

causes, symptoms, diagnosis and treatment

I confirm More

INVITRO
Library
Disease Handbook
Trichotillomania

Alopecia

Depression

Neurosis

1967 09 September

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Trichotillomania: causes, symptoms, diagnosis and treatment.

Definition

Trichotillomania (TTM) is a chronic traumatic alopecia caused by a mental disorder characterized by regular pulling out of one's own hair from the scalp, eyebrows, eyelashes, pubis and other parts of the body. Patients with TTM often suffer from other mental disorders (eg, depression, neurosis).

Trichotillomania can be an independent disease or develop against the background of bipolar disorder, schizophrenia, organic brain damage.

The first signs of trichotillomania appear, as a rule, in childhood or adolescence, although cases of TTM manifestation in adults have been described - in this case, the prognosis for cure is less favorable.

Statistics show that the prevalence of pathology is approximately 0.9%, but doctors say that the numbers may be higher, since many patients do not seek medical help. Women suffer from trichotillomania twice as often as men.

Causes of trichotillomania

The main reason for the formation of the hair-pulling habit lies in the psychological problems of the patient: the disease can develop against the background of stress, increased anxiety, self-doubt, difficult relationships in the family (lack of mutual understanding causes chronic stress in the child, which can become trichotillomania).

There is a theory, which does not yet have solid evidence, about the hormonal nature of TTM. Its supporters focus on the fact that in many patients the manifestation of the disease coincides with the period of puberty, when there are significant changes in the hormonal background.

Classification of the disease

According to the ICD-10 classification, trichotillomania belongs to section F63 “Disorder of habits and drives”.

Trichotillomania can be unconscious (automatic), when the patient does not realize that he is pulling out his hair, and conscious, when pulling out his hair becomes a response to a stressful situation, increased tension and allows for some time to get rid of anger, frustration and anxiety. A combination of these two types of TTM is also possible.

Trichotillomania is classified based on the age of the patient when the disease debuted:

childhood trichotillomania occurs in children 2-6 years of age;
adolescent trichotillomania develops at 11-15 years of age;
bidominal trichotillomania is manifested by two clinical peaks: first in preschool and then in adolescence;
adult trichotillomania.

Symptoms of trichotillomania

Specific manifestations of trichotillomania include pulling out one's own hair, twisting it around a finger, sucking, and there are cases when patients chew and swallow their torn hair. Patients with TTM can often touch their hair without even pulling it out, and the act of pulling out their hair always brings them emotional relief.

The clinical picture of the disease is represented by foci of total alopecia of irregular shape (bald patches can be localized where there is hair, but more often on the crown and crown) or areas with sparse hair (in this case, hair broken off at different heights, with split ends, or rolled into rings).

Pinpoint hemorrhages (hemorrhages) can be visualized on the skin due to hair pulling. With total hair pulling, hemorrhagic crusts and erosions, foci of lichenification (thickening and thickening of the skin) are often formed.

Hair pulling usually does not bring any pain to patients, since the sensitivity in these areas of the skin is reduced.

Diagnosis of trichotillomania

Diagnosis of TTM is difficult because patients do not recognize the very fact of hair pulling, and the clinical picture of trichotillomania is similar to other alopecia, so in about 50% of cases, patients with TTM are initially diagnosed with alopecia areata. Differentiation of two pathologies allows the analysis of the totality of pathological trichoscopic signs and key disease markers. Trichotillomania is characterized by the preservation of pigmented short hair and different lengths of hairs, with alopecia areata, the hair is discolored and thin.

To detect the disease, trichoscopy is considered the main diagnostic method - a computer study of the condition of the hair and scalp using a trichoscope, which is equipped with a video camera and magnifying optics.

Trichotillomania is distinguished by the presence of several types of hair: hair with normal ends, hair with ends in the form of a brush, twisted hair. Many empty follicles are found, some of them with black patches of remnants of the hair shaft (trichomalacia). Histological examination may be required to clarify the diagnosis.

Key disease markers include:

habit of regularly touching and pulling hair;
emotional tension before hair-pulling;
emotional relaxation after hair-pulling;
absence of other dermatological and trichological pathologies.

The fluorescent test is used in cases where the patient and his relatives do not recognize the fact of hair pulling. To conduct the test, the hair is treated with fluorescent ink, and every other day the skin of the hands is examined under a Wood's lamp. A characteristic glow of the skin indicates that the patient often touches his hair.
The doctor may recommend a study of the composition of the hair for trace elements in order to prescribe drugs for hair restoration.

Small hair trace element screening

Up to 5 business days

Available with home visit

4 410 RUB

Add to cart

Which doctors to contact

Patients with problems of hair thinning and total baldness turn to trichologists and dermatologists. Of course, these specialists are engaged in local therapy.

Nevertheless, trichotillomania is a mental disorder, so its treatment should be comprehensive, and one cannot do without the help of a psychiatrist.

However, if a patient does not present to a doctor for trichotillomania, the disorder may be suspected general practitioner during a visit for a different reason, paying attention to the bald patches and the emotional status of the patient.

Treatment of trichotillomania

First of all, patients with trichotillomania need the help of psychiatrists and psychologists. Doctors find out what factors or circumstances lead to episodes of hair pulling, and give recommendations on how to eliminate or minimize them. For treatment, hypnosis, psychotherapy and antidepressants can be used, and in the presence of itching - glucocorticosteroids locally.

Some studies show that as an adjunctive therapy, the patient, when feeling the urge to pull his hair, can begin to do self-massage of hands, touch beads or rosary.

Complications

Since it is common for some patients to swallow torn hairs (trichophagia), there is a risk of clumps of hairs forming in the stomach, making it difficult to pass and digest food and may require surgery.

Another consequence of constant hair pulling is infection of the injured skin.

If the patient pulls out hair for a long time, hair growth may stop altogether.

Prevention

Preventive measures in childhood are reduced to educational moments: children who are prone to anxiety and self-doubt should not be criticized, set strict limits on them and compared with others - in other words, it is important for such children to ensure a minimum level of stress.

Adolescents and adults should avoid stressful situations as much as possible and relieve emotional tension through sports (eg swimming).

Sources:

Tikhonovskaya I.V., Lesnichaya O.V. Trichotillomania: clinic, diagnosis, differential diagnosis, treatment // Medical News. No. 1, 2014. S. 12-15.
Efanova E. N., Rusak Yu. E., Gorshkova A. V., Vasilyeva E. A. Trichotillomania and trichobezoar in a teenager: a clinical case. Questions of modern pediatrics. 2019; 18(2): 134-137. doi:10.15690/vsp.v18i2.2016

IMPORTANT!

Recommendations

Optic nerve atrophy

873 07 November
Cavernous tuberculosis

866 03 November
Sialoadenitis

3314 02 November

Show 9 more0003

Obsessive thoughts

Obsessions

Compulsions

Depression

Schizophrenia

Bipolar disorder

Anorexia nervosa

Bulimia

Tourette syndrome

Obsessive-compulsive disorder

Obsessive-compulsive disorder: causes, symptoms, diagnosis and treatment.

Vegetovascular dystonia

Depression

Nervous breakdown

Neuroses

Patients with neuroses are characterized not only by complaints of anxiety and depression, but also by symptoms such as palpitations, feeling of a coma in the esophagus, pain and dyspepsia. At the initial stage, the treatment of neuroses can be very effective, so it is important to notice these disorders in time.

Climax

Menopause

Hypertension

Diabetes mellitus

Obesity

Hormonal disorders

Migraine

Neurosis

Multiple sclerosis

Myoma

Vulvit

Cervicitis

Depression

Anxiety disorders

Frigidity

Frigidity: causes, symptoms, diagnosis and treatment.

Thyroiditis

Myxedema

Infertility

Osteoarthritis

Gallstone disease

Depression

Dementia

Alopecia

Bradycardia

Hypothyroidism

Hypothyroidism: causes, symptoms, diagnosis and treatment.

Learn more