Trichotillomania: the strange obsession with plucking hair

the knitting is a strange disorder characterized by the overwhelming urge to pull your hair, usually your scalp, eyebrows, and eyelashes.

Although individuals suffering from this condition are aware of the harm that can be caused by acting in this way, they are unable to stop or control this impulse. In addition, it is common for these people in times of stress to try to pull their hair out to calm themselves down, which creates a vicious cycle that can cause significant damage, both physically and psychologically.

What is trichotillomania?

this condition Usually appears around the age of 13 and is officially classified as an impulse control disorder., Like pyromania, kleptomania or pathological gambling. It is also closely related to obsessive-compulsive disorder, as they share a large part of the maladaptive psychological symptoms and mechanisms.

It has a prevalence of 1% of the population and affects both men and women, although the latter seek treatment more frequently.


trichotillomania is characterized by the presence of the following symptoms:

  • Tearing the hair recurrently causing noticeable loss (as can be seen in the photo).
  • An increase in the perception of tension just before tearing your hair or resisting the act.
  • Pleasure, gratification or liberation when stretching hair.
  • The disorder is not explained by any other mental disorder or medical condition.
  • The alteration causes significant discomfort or deterioration in social life, employment or other important areas of activity. For example, loss of self-esteem as a result of partial alopecia caused by pulling out hair.

Traffic signs

The appearance of this disorder it occurs around the age of 13, although in some cases it can start earlier. Often times, a stressful event can be associated with this condition, for example, changing schools, child abuse, family conflict, or the death of a loved one can lead to anxiety and nervousness and cause the onset. of this disorder.

Some experts claim that symptoms can be caused, or at least strongly influenced, by the hormonal changes inherent in puberty.

Most probable causes

Adolescence is a critical stage in the development of self-esteem, body image, self-confidence or intimate relationships. During this period, people suffering from this condition may be ridiculed by their own family, friends or classmates. But in addition, these people may feel great guilt or shame at not being able to stop this type of behavior. Even a small spot without hair can cause serious emotional problems for the person suffering from this condition.

In many cases, people who suffer from trichotillomania manage to lead a normal life: get married, have children … But in some cases, there are individuals who avoid intimate relationships for fear of exposing their disorderO.

There is no specific cause for trichotillomania. Although some researchers believe that it is possible that at the biological level there is a neurochemical mismatch at the brain level, mainly serotonin deficiency. There may also be a combination of factors such as genetic predisposition and worsening stress or circumstances. For example, a traumatic event.

Comorbidity (associated disorders)

People with trichotillomania often have symptoms of obsessive-compulsive disorder (OCD) such as counting or washing their hands. In fact, there are many similarities between trichotillomania and OCD, so some experts consider it a subtype of obsessive-compulsive disorder.

Depressive disorder is also common with trichotillomania. There may be a direct relationship between the neurotransmitters involved in depression and this condition (as well as OCD), as both conditions are associated with low serotonin levels. Although there may also be a relationship between depression and low self-esteem caused by trichotillomania, as tearing your hair can be demoralizing. On another side, when the hair is pulled, injuries can occur and cause physical and emotional pain.


Trichotillomania can be treated in two ways, according to research in this area.

1. Psychotherapy

On the one hand, cognitive behavioral therapy is very effective. On the other hand, and in some serious cases, the administration of drugs is necessary. However, the ideal is the combination of the two treatments.

With cognitive behavioral therapy, patients learn to identify and manage symptoms and use strategies that help them improve their quality of life. You can read more about this type of therapy in our article: “Cognitive-behavioral therapy: what is it and what are the principles behind it?”.

2. Pharmacology

Medication can also be effective in treating symptoms, although for long-term results cognitive behavioral therapy is necessary. Some medicines (antidepressants or mood stabilizers) used to treat this condition are:

  • Fluoxetine (Prozac)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Clomipramine (Anafranil)
  • Valproate (Depakote)
  • Lithium (Lithobid, Eskalith)

Bibliographical references:

  • Christenson GA, Crow SJ (1996). “The characterization and treatment of trichotillomania.” The Journal of Clinical Psychiatry. 57 Suppl 8: pages 42-7; discussion. pages 48 to 49.
  • Christenson GA, Mackenzie TB, Mitchell JE (1991). “Features of 60 chronic extractors for adults.” The American journal of psychiatry 148 (3): pp. 365-70.
  • Salaam K, Carr J, Grewal H, Sholevar E, Baró D. (2005). Untreated trichotillomania and trichophagia: surgical emergency in an adolescent. Psychosomatics (in English).
  • Woods DW, Wetterneck CT, Flessner CA (2006). “A Controlled Assessment of Acceptance and Commitment Therapy Plus Trichotillomania Pattern Reversal.” Behavioral Research and Therapy 44 (5): pages 639-56.
  • Zuchner S, Cuccaro ML, Tran-Viet KN, et al. (2006). SLITRK1 mutations in trichotillomania. Mol. Psychiatry (in English).

Leave a Comment