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Trichotillomania — Hair-Pulling Disorder

Body-focused repetitive behavior characterized by recurrent pulling of one's own hair leading to noticeable hair loss, distress, and functional impairment.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Trichotillomania — Hair-Pulling Disorder?

Trichotillomania (TTM) is a body-focused repetitive behavior (BFRB) where individuals pull hair from the scalp, eyebrows, eyelashes, beard, pubic, or axillary regions. Pulling may be 'focused' (deliberate, often in response to negative emotions) or 'automatic' (outside awareness, while reading, watching TV, etc.).

Pathogenesis combines genetic predisposition, dysregulation of fronto-striatal-thalamic circuits, glutamatergic and dopaminergic dysfunction, and reward-based learning. Comorbidities include depression, anxiety, OCD, ADHD, and skin-picking disorder (excoriation).

Dermatologic exam reveals patches of hair loss with broken hairs of different lengths, normal scalp without inflammation or scarring (in non-tonsure pattern). Trichoscopy shows broken hairs, V-sign, flame hairs, hair powder. Differential includes alopecia areata, traction alopecia, tinea capitis, telogen effluvium.

Symptoms

Patches of hair loss with broken hairs of varying lengths
Areas of stubble or short regrowth alongside normal-length hair
Tonsure-like pattern (top-of-head loss in some patients)
Loss of eyelashes, eyebrows, body hair
Bald patches on accessible scalp regions (right-handed: left side)
Trichophagia (eating hair) with risk of trichobezoar in 5–20% of cases
Scarring or inflammation (rare, in long-standing severe cases)
Significant emotional distress, social avoidance

Risk Factors

Female gender (4:1 in adults; 1:1 in children)
Onset typically age 10–13 years
Family history of TTM, OCD, or anxiety disorders
Comorbid anxiety, depression, OCD, ADHD
Stressful life events, trauma history
Sensory processing differences
Skin-picking disorder, nail-biting, lip-biting

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent hair loss in patches without scalp inflammation — dermatology and mental health evaluation
  • Compulsive hair-pulling causing distress or functional impairment
  • Trichophagia with abdominal pain, vomiting — gastrointestinal evaluation for trichobezoar
  • Severe psychological distress, depression, suicidal ideation — urgent mental health support
  • Social withdrawal, school avoidance in children due to hair loss

Treatment Methods

01
Cognitive-behavioral therapy (first-line): Habit Reversal Training (HRT), Comprehensive Behavioral Treatment (ComB), Acceptance and Commitment Therapy (ACT) — 50–70% improvement in pulling and distress
02
Habit Reversal Training components: awareness training (logging triggers and pulling episodes), competing response (clenching fists, sitting on hands), social support, generalization training
03
Stimulus control: removing triggers (mirrors, tweezers), barriers (gloves, bandaids on fingers, hair clips), environmental modifications
04
Pharmacotherapy adjuncts: N-acetylcysteine (NAC) 1200–2400 mg daily — best evidence in adults; SSRIs (fluoxetine, sertraline) limited efficacy; clomipramine for OCD-prominent cases; olanzapine in severe refractory cases
05
Mindfulness and emotion regulation training to address focused-pulling triggers
06
Family therapy for pediatric patients: parental coaching, family-based HRT, school accommodations
07
Dermatologic care: gentle hair care, avoid harsh chemicals, scalp moisturization, address concurrent traction or seborrheic dermatitis
08
Cosmetic options: wigs, hair extensions, eyebrow tattooing/microblading, false eyelashes for body image support
09
Trichobezoar evaluation: abdominal exam, imaging, gastroenterology consult; surgical or endoscopic removal if obstruction
10
Long-term: relapse prevention, support groups (TLC Foundation), online communities, psychiatric monitoring for comorbidities

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.