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What is Trichotillomania?

Sally Foster
Updated: Mar 03, 2024

Trichotillomania is a rare impulse control disorder in which the sufferer compulsively pulls out his or her own hair. People with trichotillomania most commonly pull hair from their scalp, eyelashes, eyebrows, or pubic area. While most people with trichotillomania pluck each hair out at the roots, others may pull out large handfuls at a time.

Trichotillomania usually begins in childhood or adolescence, frequently coinciding with the onset of puberty. While some children develop hair-pulling habits that subside with age, other individuals continue the behavior throughout adulthood. It is estimated that between one and three percent of Americans suffer from trichotillomania. Of those individuals, approximately 80% are women.

The direct causes of trichotillomania are unknown; however, many people with the condition also experience similar impulse control disorders, such as skin-picking and nail-biting. In many cases, the individuals suffer from depressive disorder or obsessive-compulsive disorder as well. Some evidence suggests that trichotillomania may be genetic or the result of a chemical imbalance. Stress is also believed to play a large role, as periods of high stress have been known to heighten the condition.

People with trichotillomania are often embarrassed or ashamed about their behavior, leading them to hide it from others. Because of this, low self-esteem is very common among sufferers. Furthermore, the compulsive removal of hair can lead to bald patches on the scalp or eyebrows, which contribute to the sufferer's embarrassment and depression.

In some cases, trichotillomania is accompanied by trichophagia, or the swallowing of extracted hair. This can result in the formation of a gastric bezoar, also known as a hairball. Gastric bezoars are extremely dangerous and may require surgical removal to prevent intestinal blockage.

Because trichotillomania is a behavioral disorder, treatment is usually psychological. The most successful form of treatment, known as Habit Reversal Training (HRT), focuses on increasing the patients' awareness of when and why they pull their hair out. Psychologists then aim to train patients to redirect the impulse. In some cases, antidepressants are also effective in treating trichotillomania.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.
Sally Foster
By Sally Foster
Based in Istanbul, Turkey, Sarah is a freelance writer who has experience teaching English language courses and running an expat community blog. Since joining the The Health Board team several years ago, Sarah has become a veritable fount of knowledge on many obscure topics. She holds a B.A. from the University of Oregon, where she majored in Romance Languages (Spanish and Italian) and Linguistics, and an M.A. in TESOL from the Middlebury Institute of International Studies at Monterey.
Discussion Comments
By anon991658 — On Jul 07, 2015

I am a 37 year old male and I have twirled my hair since birth. I am twirling right now. It zones me out.

I pluck 'imperfect' beard/stache, brow hairs, chest hairs, ear hairs, and nose hairs. At times I end up looking moth-eaten.

If a hair comes out root whole with a 'juicy' end, I'll nibble that.

A close shave makes it almost impossible, but then I sometimes start 'digging' and that's the worst.

I noticed my daughter starting to twirl her hair and that caused me to look it up. I'd never heard of it before, and have only seen twirlers in movies -- rarely in public.

They seem to be 99 percent women (evidently 50/50). I love twirling, even though U know it makes me look odd.

I hate plucking. I feel compelled, out of control, automatic.

By anon966735 — On Aug 21, 2014

I am a 29 year old male. I have suffered with trich for as long as I can remember. I don't seem to pull at my hair anywhere else but my eyelashes. Through extensive pulling, my eyelashes have now grown as though they are tangled and it makes my eyes very itchy. My eyelashes have always been very long so maybe that's another reason. I heard nail biting is another form, which I do all the time.

By anon346222 — On Aug 26, 2013

I'm a 51 year old male. Recently I lost 75 percent of one eyebrow. I don't know what happened to cause this. I don't believe I'm pulling it out, but may be at night while sleeping.

By anon326261 — On Mar 20, 2013

I have the issue of biting off my hair, mostly searching for dead ends. I don't actually pull them out but sometimes a few fall out in the process because I'm constantly touching my hair. I mostly do this unconsciously when working on the computer, reading or watching an exciting movie. I'll notice that I have been doing it afterwards because I'll find a bunch of hair lying next to where I've been sitting and as you may imagine, it is pretty embarrassing.

By anon314453 — On Jan 18, 2013

I am an eyelash and eyebrow puller. The first thing that helped me is when I heard it was a condition. Somehow, that made me face up to the issue and not keep saying, "Oh, I can just stop one day."

I have been pull free for about six months now, and after 20 years of pulling, that feels great. My eyelashes have grown back in (phew). They are thinner than they probably would have been, but they are there. I'm always worried I'll slip back, but for the moment I'm OK.

I've been using something called the Trich Stop System, which has been the best thing I've found up until now (and believe me - I've tried a lot of things!). It's a really good mix of different methods, and it comes with some hair growth oil that you can use to rub into to your skin and eyelids to make you stroke instead of pick. You could probably make up some of your own oil, but I've tried and can't seem to replicate it.

In any case, the guide and workbook that comes with the oil is pretty good too. There is a book on Amazon by the same author, but a kit that is sold online. In any case, I recommend it. Good luck to all you other trichsters out there.

By anon310696 — On Dec 26, 2012

It was only five years ago when I started impulsively pulling out my hair, which began with just a 5 cm strand using tweezers.

Right now, I am 26 years old and it's been a real struggle to overcome this habit. I hate the fact that I find it necessary to do it (only at home) in order to release whatever is bothering me, which includes a myriad of things. But then an hour or two later, I find my fingers and arms getting sore from the constant tugging because it's just so hard to stop. There are times when I just lose track of time; I sometimes end up in a trance.

The only thing I have is antidepressants, which I use as well to treat my anxiety and depression. I've tried many things to prevent myself from reaching my scalp and feeling the parts where much of the hair has been plucked and new hairs have grown. It drives me nuts because I get so self-conscious about my hair and I hardly wear my hair down in public anymore (mainly I pull in the center) and the only thing I do to cover up the bald areas is to tie it in a bun or something. I wish there were more methods to treat this problem seeing as how medication rarely does anything to reduce the urge. *Sigh.*

By anon292663 — On Sep 21, 2012

I think I've played with my hair as soon as it it grew from infancy and I must have enjoyed the feeling as it's never stopped. However, that is the harmless side of the complaint - I also pluck my eyebrows with my fingers and hardly ever have any left. An old friend, who I've not spoken to for over 10 years asked me, when we finally and recently did converse; 'Are you still pulling your eyebrows out?'

'Sure am", I said. 'Oh dear,' said he.

By anon245275 — On Feb 04, 2012

Since my son grew hair, he would always twirl the front of it mindlessly, like when listening to a story or daydreaming. I always associated it with happening while he's thinking so I never thought much of it. Now that he's 4, he insisted upon me letting him grow out his hair- I had previously always kept it buzzed, except a tiny bit longer in the front/top. So now that he has long hair, I noticed a rather large bald spot forming, quickly.

About a week ago it was the size of a quarter, and now it's about four inches long across the top of his head where he twirls it. After doing research and reading this, I am very concerned. I would hate for this to get worse and I wonder what could be wrong? I've always been a fairly strict mom. I've always told him and his sister about the importance of eating healthy, and exercising, and brushing their hair and teeth, being clean, etc. They even know how to do laundry by themselves, although I never make them do it! He begs me to help when I do laundry.

I hope I haven't put too much on his shoulders/ stressed him out!! He's only four. I would never consider putting him on meds. Maybe if I ease up a bit and don't make him clean up after himself and don't overload him with information? I don't know. I'm at a loss. If I only knew the problem, I would do everything in my power to help him. Any suggestions? I'm very worried about the direction things could go.

By anon191587 — On Jun 29, 2011

I am a 25 year old male and suffered with Trich since I was four years old, following a traumatic crash accident. Luckily I managed to combat the problem about two years ago but the damage was already done on the crown of my head.

I wanted to post this to say there is hope for any sufferer out there. My family and I have been to hell and back trying to understand and treat my condition but it seems there are a lot of theories about Trich but no proven evidence of what exactly causes it. One problem I always found I had was I never had the confidence to tell people about my problem and people just presumed I lost my hair naturally.

Over time, I have learned to become far more confident and when people joke or mock me about my hair loss, I tell them about my struggle with Trich. I have been saving for the past couple of years to have FUE hair replacement therapy to try and restore my hair and my confidence completely so I can continue a normal life.

Please keep your head held up high. A lot of people have problems/health conditions, it is just that ours is physically noticeable that makes a difference.

By anon176863 — On May 16, 2011

My mother squeezed my zits all through puberty, and was constantly poking at me and straightening me out to look "perfect". My dad died with about 25 nail clippers. I'm constantly manicuring my nails, and have plucked every hair from my eyebrows leaving scabs and scars. I actually "dig" out the new growth. It's ugly but I don't know how to quit?

By anon162089 — On Mar 22, 2011

I am a 44 year old female and have been pulling since puberty. The urge to pull is often very extreme and I have a large bald spot on the back of me head. the only way I can hide this is by wearing a pony tail. It has damaged my self esteem tremendously. I am without a doctor as many are in the area where I live. Wish I could stop.

By anon141886 — On Jan 11, 2011

I'm a 16 year old male and i have been pulling since i was 4 or 5. i usually just wear a hat now to stop me from doing it. When i twist and tangle my hair, it creates a really good satisfying feeling and i do it sometimes without even knowing. Just wondering if any one else has a similar situation and maybe some tips.

By anon139926 — On Jan 06, 2011

I’m a thirty year old man and I have suffered with Trichotillomania since I was four years old. I watched a documentary on channel 4 in the UK and came to realize that I am not the only one with is problem, as when I was child no one really talked to me about it.

I saw psychologists and doctors, but it was never explained to me and as I got older it became a normal thing with in the family and myself, so it was never discussed. I often felt very ashamed of my hair pulling and it destroyed my confidence. But in a never way it’s a comfort! I now keep my hair on my hair on my head short, so it’s hard for me to start there. But I’ll pull hair from all over my body still so times I don’t realize I’m doing it.

It generally gets worse when I get stressed. I would like to find out if there are more men out there with the condition. Thank you.

By anon131059 — On Nov 30, 2010

Trich isn't rare, do your research. About 3-5 percent of the world suffers from trich admittedly. On top of that, it is thought that it is equally common in men, but pulling from the scalp is more noticeable in women than men.

By anon129594 — On Nov 24, 2010

TTM is caused by diet. I have had it since I was eight. I found though, that when I was pregnant I had no desire to pull. I had cut out sugar, and my hormone levels had changed.

Recently I found that a Dr. had done a study in which he treated TTM with NAC - N-acetylcisteine. I've pretty much cut out sugar (it's hard - everything has sugar!), and take NAC and as long as I do that I have no urge to pull. Try it, and good luck! --M

By anon110922 — On Sep 14, 2010

I have had this since I was five years old. I'm 52. It was much easier to hide when I was younger. I am a social scientist and can't find any agreement in the scientific community about its origins.

By anon110120 — On Sep 10, 2010

I constantly twirl my hair and have since i was a child. Even when my step dad would threaten to cut my hair off I couldn't stop, and now I'm in my twenties and what was just hair twirling has grown into an addictive tweezing problem (and I still constantly twirl without realizing I'm doing it).

My legs have been demolished by tweezers and i refuse to think this is a psychological issue. I think it's more physiological and having to do with the nervous system. I don't do it because I'm stressed or bored, i just do it, and once i start i can't stop.

I've also been an avid skin picker ever since acne appeared on my face. I'd like a cure please and thank you.

By anon89637 — On Jun 11, 2010

There needs to be much more information about TTM available to everyone. Too often do I stumble across "articles" about this condition that are misleading, outdated, or simply just incorrect.

This is due to the extreme lack of research into this problem, even though millions suffer from it. Don't forget, those statistics come from people who have actually told someone they have it. Most people will keep it to themselves.

Also, from what other TTM sufferers have told me, anti depressants have mostly proven to actually worsen the "urges" of TTM, thereby only solving the depressive aspect of it and not the problem itself.

One day there'll be suitable treatment.

By anon81129 — On Apr 30, 2010

Thanks a lot for your kind information.

By anon42632 — On Aug 22, 2009

Trichotillomania is not 'rare'. This article starts by saying that it is rare, but then goes on to state that between one and three percent of Americans are thought to have it. That is not rare at all. it is very common and the more people that are aware of trich the better in my opinion.

By anon37620 — On Jul 20, 2009

I have been doing this since 1970. I do not swallow the hair by any means. But I do bite the clear end where the mitochondirial DNA is found and spit that out.

By anon37590 — On Jul 20, 2009

I have suffered from this from puberty. I just turned 60 and still have it to a lesser degree. Back in the 60's when it first started my family tormented and mocked me. I'm glad to see I'm not the only one.

By anon37527 — On Jul 20, 2009

I have a daughter in law who has this - has had it for years. She used to have beautiful hair; now she wears scarves on her head and looks like a chemotherapy patient. THanks for the information; I didn't know what this is called.

By anon37499 — On Jul 20, 2009

Why do doctors assume that it is psychological? It could also be physical...

By anon37476 — On Jul 20, 2009

I'm really glad to see this disorder is finally entering the zeitgeist. The more attention it receives, the more funding may eventually be available to find a cure. It's devastating condition for sufferers and their families.

By ivanka — On Jun 26, 2008

Even though this disorder was known to exist even in ancient Greece, it was largely an obscure disorder. Trichotillomania did not become a "disorder" until 1980's. I hope some day soon, we will find out what is the cause of it and how to treat it.

Sally Foster
Sally Foster
Based in Istanbul, Turkey, Sarah is a freelance writer who has experience teaching English language courses and running...
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