Trichotillomania is a chronic, recurrent compulsion to pull one’s hair that results in physical as well as mental and emotional pain.
Trichotillomania is a disorder that affects 1-2% of the population, a majority of them female. Symptoms usually start in adolescence following puberty. The main feature is the recurrent compulsion to pull out one’s hair. Hair is pulled from any area of the body, the most common being scalp, eyebrows, and eyelids. Episodes of hair pulling vary over time and can be cyclical, but a person will spend a considerable amount of time doing it, sometimes several hours per day.
Another key symptom is recurring attempts to stop or decrease hair-pulling behaviors.
Also, the behavior causes significant distress in a person’s life. This distress causes dysfunction at school, work, or in social settings are other areas of functioning. Finally, the compulsion to pull hair cannot be explained by another medical problem or another mental health problem.
There are many reasons to pull hair. In some cases, hair pulling gives an emotional release, a way to focus on a different type of pain, or a way of soothing. For some, pulling hair leads to gratification or pleasure. Not all who pull hair do so consciously. While some pull hair with full awareness, there are others who do it without noticing what is happening.
Compulsive hair pulling is a stressful disorder often hid from family and friends. A cycle of negative emotions goes with the behavior including guilt, shame, and embarrassment. Many people who suffer from compulsive hair pulling prefer isolation, withdrawing from social interaction for fear of judgment. A person is left to deal with the disorder alone, internalizing negative emotions and often struggling with depression and anxiety. Not only do those feelings spark anxiety, but anxiety can worsen hair pulling activity.
Many people who struggle with trichotillomania, or compulsive hair pulling, associate hair pulling with anxiety. One study found that out of 894 people struggling with trichotillomania, 84% of them said anxiety was associated with it. Others report that hair pulling gets worse when anxiety increases.
In addition to the mental and emotional distress of the disorder, there are physical health risks as well. Pulling hair out at the roots on the scalp can result in permanent damage. People who suffer from trichotillomania often have spots where hair no longer grows or the hair that grows is not healthy. Scabs and infections can develop on the scalp resulting in severe discomfort or disfigurement. If eyelashes are pulled, it can result in a condition called blepharitis, inflammation of the eyelids. Pulled hair that is swallowed can cause digestive problems.
Trichotillomania is a chronic, compulsive disorder that if left untreated can cause significant distress and pain. The good news is treatment is available. Therapists who specialize in treating body-focused repetitive disorders use a variety of evidence-based treatments to help clients manage symptoms and address any co-occurring issues like anxiety or depression that exacerbate hair pulling. There are many people who find hope and manage symptoms with treatment and a supportive community.
About the Author: Trudi Griffin
Trudi Griffin is a NCC Licensed Professional Counselor putting her clinical knowledge, experience, and passion for research to write about mental health for publications such as www.trichtop.com. She earned a Master of Science degree in Clinical Mental Health Counseling: Addictions and Mental Health from Marquette University (Milwaukee, WI), and is a double graduate of the University of Wisconsin Green Bay with Bachelor’s degrees in Communications and Psychology.
My daughter’s trich started at age 11 and while it has continued through age 17 (current), it turned out to be the first noticeable symptom of Lyme disease and co-infections (especially Bartonella). Children’s symptoms are often the more “psychological” type symptoms, but they are not making it up! See this book for a list of symptoms more people in the mental health profession need to know—I wish I’d had it 6 years ago.
When Your Child Has Lyme Disease: A… https://www.amazon.com/dp/0996224300?ref=yo_pop_ma_swf
Hi Laura,
Did your daughter’s trich subside after treating for Lyme and Bart?
My daughter also has trich and we’re going down the path of testing for Lyme and co-infections.
Thanks,
Melissa
I started hair pulling and eating at about 12 years old. My teenage years were awful. I was practically bald. Gradually my pulling slowed down but didn’t cease for about 40 years. I’m now 60 and have a full head of hair. I think mine started when I changed schools and didn’t have any friends, and by pulling my hair I had no chance of making friends, it was a vicious circle. I had no medical help or support and was extremely depressed. It became a habit. My hair was growing back but I still continued to pull, but I managed to control it so I looked normal. Never went to a hairdresser. Couldn’t bear to have people behind me and never went outside if it was windy because I glued what hair I had done in place to cover bald areas with tons of hairspray.
I feel fortunate now that those days are over, if I can offer support in any way I will.
I’m so pleased to hear you found your way through. Thank you for sharing your story. There is something very powerful in ‘me too’.
My 13 year old daughter started pulling her hair out about a year and a half ago. She was seeing the school counselor and it was helping. She can’t see that counselor any longer. There are so few counselors that work with children and the ones that do are far beyond what I can afford. I don’t know what to do. I want to help so badly.
I can hear how distressing this is for you. It is so awful watching our children struggle. You are an incredible source of support for your daughter, and if professional support is out of reach right now, there are things you can do to help her through. Here are some resources that might help. There are articles on this link https://www.heysigmund.com/category/with-kids/anxiety-in-kids-and-teens/ and videos on this link https://www.heysigmund.com/category/with-kids/anxiety-videos-for-kids/. I hope this helps. Love and strength to you and your daughter.
The anxiety may have a physical cause as we found in our family. We found solutions that help through Dianne Craft, “the biology of learning” (www.diannecraft.org), and Trudy Scott, “the antianxiety food solution” (www.antianxietyfoodsolution.com).
1. Not always in just teens and adults, my son was 7, my neice about 7 and second son 3. They have since managed to control it (mostly).
2. I believe it is a symptom of something else, mostly anxiety of some kind and then the anxiety could be symptom of something else like sensory disorder for example. I doubt it occurs on it’s own.
3. Would be Interested if there was any research showing percentage of symptoms within family members, therefore suggesting it could be genetic.
Wow, I’m so sorry to hear that such young people do this.
As for me, I know it is stress and anxiety. It can be traced to when we moved here in 2010. But I had been self-mutilating with a razor for about 15 years, so I feel it is just another expression of severe stress.
As for genetics, only my niece (14) cut her wrists superficially. She is the only family member to my knowledge that has done something like this. Maybe one other person besides myself is not enough to call it genetic, but again I don’t know the full history of my relatives.
I think we must remember that animals injure themselves as well while under extreme stress. Birds are the biggest examples of this, as they can pluck their feathers out until they are bald. Dogs can bite and chew their toes. It is of note that this behavior does not occur in the wild, but only in domesticated animals. Entirely stress induced.
Thank you for sharing. I know it is hard for me to write this. No one but my husband knows about the cutting, though obviously the hair pulling and breaking is quite apparent to him.
It pleases me that your children have been able to gain control over this. It seems we adults have a more difficult time, even with help. With children that young, some other mechanism besides anxiety could be at play.
Although no doctor acknowledged this as a cause, my son suffered from this while having a spinal leak. I think it was either due to the low fluid in his brain, or due to extreme pain. He was unaware of doing it. I think physical causes should be addressed. He never did this before or after the CSF leak. It could also have been a medication side effect. They thought he had psychological issues, but a comprehensive psych exam confirmed he was one of the most stable teens she had examined. Once a doctor understood and repaired the leak, all symptoms were gone.
Mary thank much for sharing your story. All information adds to our shared experience and moved us closer to understanding what we need to know.
I love seeing these disorders being highlighted. I have dermatillomania, which is related to trichotillomania in both the underlying motivation and effects on the individual suffering from it. It’s still surprising to me they are not considered a very specific subset of OCD, and that very little research is done on them as a whole.
Yes it’s such important information isn’t it. Hopefully the more we talk about it, the more research we’ll start to see in the area.
My sis noticed my great niece pulling out her hair. Sis said she looked over at my g. niece and she had a pile of hair on her lap, and she was separating small amounts of hair before she would pull it out.
She said it feels good. I’m very worried about my niece. (Her dad yells at them a lot. He is very selfish. She also has diabetes) what can I do? Please help.
This may be a symptom of anxiety. Anxiety can drive all sorts of behaviours which are actually as a way to self-soothe or to distract from unwanted, anxious thoughts. This may be why your niece is saying it feels good. Anxiety is very manageable, but it will take time and persistence. If the behaviours are intrusive and getting in the way of your niece’s day to day function (family, friends, school) it might be an idea to speak with a counsellor or psychologist who can give her the support she needs. In the meantime, there are certainly things you can encourage her towards which will help. One of these is mindfulness. Research has shown that mindfulness changes the structure and function of the brain in ways that can protect and strengthen it against anxiety. If your niece is unfamiliar with mindfulness, a great place to start is the free Smiling Mind app, which has mindfulness meditations for children through to adult. It’s also important that your niece understands her anxiety. This article will help https://www.heysigmund.com/anxiety-in-kids/. There are also many other articles on this link https://www.heysigmund.com/?s=anxiety+children. For a proper diagnosis, I would encourage you to speak with a doctor or therapist. I hope your niece is able to find calm for herself soon. She is lucky to have you watching out for her.
I have been having this problem since my teenage years. God knows I tried everything to stop the pulling but none of them works.
The article mentioned body-focused therapy. Can anyone share more about this? How do I reach these therapists? Thanks!
Clara here is a link that might help https://www.trichstop.com/. Otherwise, they will hopefully be able to direct you to somewhere that will be able to give you what you need.
My son has rubbed my hair and or his since toddlerhood. I notice it more if he is sleepy. He also does this while he’s asleep. He is now 7 and I just noticed he has a bald spot on the top of his head.
I once had read an article long ago that had this behavior as a symptom of another illness. I can’t seem to find the article or one such since.
Trichotillomania is often a sign of anxiety. It can be a self-soothing habit that can happen automatically, without a lot of thought. I have just added this link to the article which might be helpful for you https://www.trichstop.com/. If you think it might be driven by anxiety, this article will explain a little more about how to deal with that https://www.heysigmund.com/anxiety-in-kids/
How about compulsive “hair cutting”? “It needs to be even.”
If the compulsive hair cutting is getting in the way, it might be worth an assessment. This can be a sign of obsessive compulsive behaviour, which is driven by anxiety. If it is causing an intrusion into day to day life, a doctor or therapist would be able to guide you on the steps to take. If it is driven by anxiety (and again and doctor or therapist will be able to guide you), managing the anxiety will make a difference.
A confession: I have a form of this disorder due to overbearing stress. It started about three years ago. I don’t pull the hair out but I break off pieces near the mid-length and bottom. Sometimes I don’t realize I do it in public.
This article is very helpful, but I am already on meds and my doctors have said unless we move away from this very stressful environment, I will continue to have this behavior. But it is so good to know that there are many others suffering with this and I’m not alone. Thank you for this. It was hard for me to write but now it is “off my chest”.
Sharon you are so NOT alone! Thank you for adding your important voice. The more people like you who can share their experience, the more the conversation happens and the more understanding there will be around this important issue.
Thank you. It has made me feel so much better; both the article and other respondents.
Overbearing stress is my cause I believe. I’m going to start online therapy ASAP. I do t know how much it will cost but I’m going to stop!! I hope…..
I remember I started when I was numbing my emotions and then I felt like the pain of pulling it out made me “feel” something.
Is there a name for compulsive skin picking? I thought it might be a symptom of OCD but I am not sure of that.
Yes absolutely – the name for compulsive skin picking is Dermatillomania. It can be driven by anxiety. (OCD is a type of anxiety.) Here is a link to more information https://www.skinpick.com/.
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karenyoung_heysigmund
Boundaries aren`t requests we make of them. They`re the actions we take to keep them (and everyone else involved) physically safe, relationally safe, and to preserve values when they aren`t able to.
The rule: Phones in the basket at 5pm.
The boundary: (What I`m going to do when you`re having trouble with the rule.)
`Okay - I can see you`re having trouble popping your phone in the basket. I`m just going to sit beside you as a reminder that it`s time. Take your time. I`ll just watch over your shoulder until you`re ready. So who are we texting? What are we watching?`
Or:
`I know you hate this rule. It`s okay to be annoyed. It`s not okay to yell. I`m not going to listen while you`re yelling.`
Then, `This phones in the basket thing is chewing into our night when we start it at 5pm. We`ll see how we go tomorrow and if it`s bumpy, we`ll shift to phones in the basket from 4:30pm. Let`s see how we go.`
It`s not a punishment or a threat. It`s also not about what they do, but about what we do to lead the situation into a better place.
Of course, this doesn`t always mean we`ll hold the boundary with a calm and clear head. It certainly doesn`t mean that. We`re human and sometimes we`ll lose our own minds as though they weren`t ours to own. Ugh. Been there too many times. That`s okay - this is an opportunity to model humility, repair, self-compassion. What`s important is that we repair the relational rupture as soon as we can. This might sound like, `I`m sorry I yelled. That must have been confusing for you - me yelling at you to stop yelling. Let`s try that again.`❤️
Nov 18
karenyoung_heysigmund
Boundaries are about what WE do to preserve physical safety, relational safety, and values. They aren’t about punishment. They’re the consequences that make sense as a way to put everything right again and restore calm and safety.
When someone is in the midst of big feelings or big behaviour, they (as with all of us when we’re steamy) have limited capacity to lead the situation into a better place.
Because of this, rather than focusing on what we need them to do, shift the focus on what we can do to lead back to calm.
This might sound like:
The rule (what we want them to do): Phones go in the basket at 5pm.
The boundary (what we do when the rule is broken), with love and leadership: ‘I can see you’re having trouble letting go of your phone. That’s okay - I’m just going to sit beside you until you’re ready. Take your time. You’re not in trouble. I’ll just stay here and watch over your shoulder until you’re done.’
Or …
‘I can see this phones in the basket process is dragging out and chewing into our night when we start it at 5pm. If that keeps happening I’ll be starting this process at 4pm instead of 5pm.’
And if there’s a bit of spice in their response, part of being a reliable, sturdy leader is also being able to lead them through that. Even if on the inside you feel like you’re about to explode 🤯 (we’ve all been there), the posture is ‘I can handle this, and I can handle you.’ This might sound like,
‘Yep you’re probably going to have a bit to say about it. That’s okay - I don’t need you to agree with me. I know it’s annoying - and it’s happening.’
‘I won’t listen when you’re speaking to me like this. Take your time though. Get it out of you and then we can get on with the evening.’
Then, when the spicy has gone, that’s the time to talk about what’s happened. ‘You’re such a great kid. I know you know it’s not okay to talk to me like that. How are we going to put this right? Let’s yet 5pm again tomorrow and see how we go. If it causes trouble we’ll start earlier. I actually think we’ll be okay though.’♥️
Nov 10
karenyoung_heysigmund
So ready to get started with ‘Hey Little Warrior’ in Melbourne. This is my fourth time this year presenting this workshop in Melbourne and we sell out every time.
So what do we do here?! We dive into how to support young children with anxiety. It’s my favourite thing to talk about. I love it. Even more than whether or not I want dessert. We talk about new ways to work with anxiety in littles so they can feel braver and bigger in the presence of it. This workshop is loaded with practical strategies. I love presenting this workshop.
(And yes - always yes to dessert. As if I would ever skip the most important meal of the day. Pffftt.)
@compass_australia
Oct 27
karenyoung_heysigmund
They’re often called sensory preferences, but they’re sensory needs.
In our adult worlds we can move our bodies and ourselves to seek regulation. If we don’t like noise we’re less likely to be DJs for example. If we don’t love heights we’re less likely to be pilots or skydivers. If we feel overwhelmed, we can step outside, go into an office, go to the bathroom, or pop on headphones for a break. If we need to move, we can stand, walk to get a tea. At school, this is so much harder.
When bodies don’t feel safe, there will be anxiety. This will potentially drive fight (anger, tantrums), flight (avoidance, running away, movement), or shutdown (in quiet distress and can’t learn).
These are physiological issues NOT behavioural ones.
Whenever we can, we need to support physiological safety by accommodating sensory needs AND support brave behaviour. What’s tricky is disentangling anxiety driven by unmet sensory needs, from anxiety driven by brave behaviour.
The way through is to support their physiological needs, then move them towards brave behaviour.
Schools want to support this. They want all kids to be happy and the best they can be, but there will be a limit on their capacity to support this - not because they don’t want to, but because of a scarcity of resources.
There will often be many children with different physiological needs. Outside school there is nowhere else that has to accommodate so many individual needs, because as adults we won’t be drawn to environments that don’t feel okay. In contrast, school requires all kids to attend and stay regulated in the one environment.
For now, we don’t have a lot of options. Yes there are schools outside mainstream, and yes there is home school, but these options aren’t available to everyone.
So, until mainstream schools are supported with the resources (staff, spaces, small classes, less demand on curriculum … and the list goes on), what can we do?
- Help school with specific ways to support your child’s physiology while being mindful that teachers are also attending to the needs of 25+ other nervous systems. But be specific.
- Limit the list. Make this a ‘bare minimum needs’ list, not a ‘preferences’ one.♥️
Oct 20
karenyoung_heysigmund
Brave often doesn’t feel like ‘brave’. Most often, it feels like anxiety. If there is something brave, important, new, hard, there will always be anxiety right behind it. It’s the feeling of anxiety that makes it something brave - and brave is different for everyone.♥️
#anxietyawareness #childanxiety #anxietysupport #anxietyinkids #parent #positiveparenting
Oct 18
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