Trichotillomania is a psychological disorder defined by the dermatologist Hallopeau in 1889. It is a form of alopecia. Trichotillomania is an ancient Greek expression which means “I am pulling hair.” Today, trichotillomania is defined as a disorder in which the person repetitively tears off his hair, resulting in a marked loss of hair. Therefore, it is an impulse-control disorder, which results in chronic hair loss.

Since it is similar to obsessive-compulsive disorder, it is within the obsessive-compulsive spectrum disorders. There are many disorders within the obsessive-compulsive spectrum. For example, eating nails, blinking, and eating disorders are some of them. Clinical symptoms and genetic predisposition may be very similar in these disorders. Also, treatment modalities may be related. In these conditions, the person has an irresistible desire to repeat unwanted behaviours.

Most of the patients with this disorder are pulling their head hair, as well as eyelashes, eyebrows, and armpit hair.  Sometimes a person feels an increased sense of tension before doing the behaviour, and then after pulling out their hair, they feel relief from stress and inner relaxation. They can do it without realizing it, just like in nail-biting behaviour.

The cause of trichotillomania is not clear. According to the psychoanalytic views, self-hatred due to psychosexual development problems is the result of this disorder. Behavioural theories define hair-pulling as an action to reduce anxiety. The presence of depression and anxiety worsens the symptoms of trichotillomania.

Treatments of Trichotillomania

Behaviour therapy and drug treatment are two methods in the treatment of trichotillomania disorder. Behavioural therapy has been beneficial for years to control, reduce, or even eliminate hair-pulling. The advantage of this treatment is the rapid relief without the risk of side effects.

Behavioural therapy, such as medical treatment, can reduce anxiety. However, it is less effective than medication in reducing other psychiatric symptoms such as depression and anxiety. Drug treatment can reduce the urge to pull out hair. But for the most part, the benefit is not permanent.

Symptoms of Trichotillomania

Almost all the patients feel high tension before the unwanted action and describe great relief and satisfaction after performing it. Pulling hair always happens when the patient is alone. The patient performs such acts unintentionally when dealing with something else, such as reading books, reading newspapers, and watching television.

People suffering from trichotillomania usually pull one strand of hair at a time. If they don’t realize what they’re doing, it could take hours. The same applies to eyebrows and other hair strands. Sometimes they go into recession and do not pull any strand for days or weeks. However, this situation is temporary. Gradually, it returns to its former state. 

The areas where the hair is pulled are usually limited to one or two, but in some patients, it can spread to a lot of areas. The scalp is the most common area for that.

In children, trichotillomania is often accompanied by problems such as nail-biting, finger-sucking, nasal-scrambling, masturbation, school problems, and the inability to live with friends.