What is trichotillomania?
Trichotillomania is a type of body-focused repetitive behaviour (BFRB). Although it shares some similarities with obsessive compulsive disorder (OCD), they are different conditions.
OCD often involves intrusive thoughts and repetitive behaviours, while hair-pulling in trichotillomania may happen in response to urges, emotions or without conscious awareness.
Body-focused repetitive behaviours
Trichotillomania is often grouped with other types of body-focused repetitive behaviours, such as skin picking (dermatillomania) and nail-biting (onychophagia). As the term suggests, these behaviours cause people to repeatedly touch their body or hair in ways that result in physical damage.
In this video, psychotherapist Eve McIntyre explains what trichotillomania is, and how CBT and habit reversal therapy can support you to stop hair-pulling.
Trichotillomania symptoms
Some people with trichotillomania report a feeling of tension or a tingling sensation immediately before or when they try to resist pulling, along with an urge to search for the ‘right hair’. Pulling the hair out is sometimes followed by a release of tension or feelings of relief or satisfaction, although not everyone experiences this. However, this is often shortly followed by a renewed urge to search for the next hair.
Other behaviours or rituals that are often reported include examining the hair closely after it has been pulled out, rolling the hair between fingers or lips, or biting it. Depending on the number of hairs pulled out, trichotillomania can cause significant hair loss in the form of bald patches. Some people with long hair can cover up these patches so they are not noticeable, but can still feel incredibly self-conscious about them. It can also prevent them from joining in activities they previously enjoyed, such as swimming.
At the age of 13, I had near enough no eyelashes, no idea why I couldn’t stop pulling them out, and an ever-decreasing sense of self-esteem. I hated myself for what I was doing but, equally, I couldn’t make myself stop.
- Becky shares her experience of struggling with trichotillomania as a teenager.
People with trichotillomania often feel shame as they think that these behaviours are unique to them when, in fact, they are a relatively common feature of trichotillomania. The hair loss resulting from prolonged pulling can also have a huge impact in terms of feelings of embarrassment, isolation and low self-confidence.
What causes trichotillomania?
The exact cause of trichotillomania is not known. Stressful life events, such as the death of a loved one, may contribute to the development of trichotillomania, but there is no single established cause.
Genetic factors may play a role in trichotillomania, although the exact causes are not fully understood. Hair-pulling may also be associated with stress, tension, boredom, or difficulty managing emotions.
Is trichotillomania the same as body dysmorphic disorder (BDD)?
Body dysmorphic disorder is a condition where someone becomes excessively worried about perceived flaws in their appearance, which may be minor or unnoticeable to others. Sometimes this can lead to repetitive behaviours, including hair-pulling, so it can be confused with trichotillomania.
Trichotillomania treatment
There are different approaches to managing trichotillomania, depending on a person's needs and experiences. Cognitive behavioural therapy (CBT), particularly approaches incorporating habit reversal training, is commonly recommended for trichotillomania. CBT can also help you explore thoughts and feelings associated with hair-pulling.
Habit reversal training (HRT)
Habit reversal training (HRT) is a behavioural technique often used as part of CBT to help people with trichotillomania. This form of treatment works by helping people become more aware of their hair-pulling, recognise potential triggers, and practise alternative responses to the urge to pull.
Hypnotherapy for trichotillomania
Body-focused repetitive behaviours such as trichotillomania are sometimes addressed with hypnotherapy, which works in a different way from traditional talking therapies or CBT. Hypnotherapy uses focused attention and therapeutic suggestions to explore habits and responses to urges. However, there is currently limited evidence to support its effectiveness specifically for trichotillomania, and it is not generally recommended as a first-line treatment.
Self-help strategies
There are also some self-help strategies that may help you manage hair-pulling. The success of self-help techniques will vary depending on your own experience of the condition.
For instance, if your hair-pulling is done consciously, the focus may be on replacing the urge to pull with an alternative action. If you pull your hair without realising it, the focus may be on bringing your attention to your hands and body so you can recognise when it's happening.
Try the following tips:
- Keep your hands busy – try squeezing a stress toy or wearing gloves to help you recognise when and where you most commonly pull your hair.
- If you feel comfortable, ask someone you trust to gently let you know when you're pulling your hair, if you think this would help.
- Don’t keep tweezers or implements you use for hair pulling in an easy-to-access location.
- Keep a diary or journal to document how you’re feeling. Noticing how certain emotions, such as stress and anxiety, affect your urge to pull can help you to understand your triggers.
Ready to find help?
If hair-pulling is affecting your wellbeing or everyday life, you don't have to manage it alone. A therapist experienced in supporting people with trichotillomania can help you explore your experiences and develop ways to manage urges. You can find a qualified, experienced therapist using our advanced search.
