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Trichotillomania: the strange obsession to tear the hair

Trichotillomania: the strange obsession to tear the hair

May 10, 2021

The trichotillomania it is a strange disorder characterized by the irresistible need to pull on the hair, usually of the scalp, eyebrows and eyelashes .

Although individuals who suffer from this pathology are aware of the damage that can be done by acting in this way, they are unable to stop or control this impulse. In addition, it is common that in times of stress these individuals try to pull hair as a way to calm down, so it produces a vicious circle that can cause major damage, both physically and psychologically.

What is Trichotillomania?

This condition usually appears around 13 years of age and is officially classified as a pulse control disorder , just like pyromania, kleptomania or pathological gambling. It is also closely linked to Obsessive-Compulsive Disorder, since they share a large part of the symptoms and unbalanced psychological mechanisms.

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


Trichotillomania It is characterized by the presence of the following symptoms :

  • Pulling the hair recurrently causing a remarkable loss of it (as you can see in the picture).
  • An increase in the perception of tension just before pulling your hair or resisting this act.
  • Pleasure, gratification or release when pulling hair.
  • The disturbance is not explained by another mental disorder or medical condition.
  • The alteration causes significant discomfort or social, labor or other important deterioration of the activity. For example, a loss of self-esteem as a result of partial alopecia caused by tearing the hair.

Warning signs

The onset of this disorder occurs around the age of 13, although in some cases it may start earlier . Frequently, a stressful event can be associated with this pathology, for example, change of school, abuse, family conflicts or the death of someone close can cause anxiety and nervousness and cause the debut of this disorder.

Some experts say that the symptoms can be provoked, or at least strongly influenced, by the hormonal changes typical of puberty.

Most likely causes

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

In many cases, people who suffer trichotillomania get a normal life: getting married, having children ... But in some cases, there are individuals who avoid intimate relationships for fear of exposing their disorder or.

There is no specific cause for trichotillomania. Although some researchers think that it is possible that at a biological level there is a neurochemical imbalance in the brain, mainly a deficit of serotonin. There may also be a combination of factors such as genetic predisposition and an aggravating stress or circumstance. For example, a traumatic event.

Comorbidity (associated disorders)

It is common for people with trichotillomania to show 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 (and also OCD), since both pathologies are associated with low levels of serotonin. Although there could also be a relationship between depression and low self-esteem caused by trichotillomania, because tearing the hair can be demoralizing. On the other hand, When hair is pulled out, wounds can appear that cause physical and emotional pain .


Trichotillomania can be treated from two routes, according to research conducted in this field.

1. Psychotherapy

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

With cognitive behavioral therapy, patients learn to identify and manage symptoms and use strategies that help them improve their quality of life . You can know more about this type of therapy in our article: "Behavioral Cognitive Therapy: what is it and on what principles is it based?".

2. Pharmacology

Medication may also be effective in treating symptoms, although cognitive behavioral therapy is necessary to obtain long-term results. Some medications (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)

Bibliographic references:

  • Christenson GA, Crow SJ (1996). «The characterization and treatment of trichotillomania». The Journal of clinical psychiatry (in English). 57 Suppl 8: pp. 42-7; discussion pp. 48-49.
  • Christenson GA, Mackenzie TB, Mitchell JE (1991). «Characteristics of 60 adult chronic hair pullers». The American journal of psychiatry (in English) 148 (3): pp. 365-70.
  • Salaam K, Carr J, Grewal H, Sholevar E, Baron D. (2005). Untreated trichotillomania and trichophagia: surgical emergency in a teenage girl. Psychosomatics (in English).
  • Woods D. W., Wetterneck C. T., Flessner C. A. (2006). «A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania». Behavior research and therapy (in English) 44 (5): pp. 639-56.
  • Zuchner S, Cuccaro ML, Tran-Viet KN, et al. (2006). SLITRK1 mutations in trichotillomania. Mol. Psychiatry (in English).

Trichotillomania: Why These Women Rip Out Their Own Hair (May 2021).

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