Daria used to make up excuses for the bald spot on the back of her head. Sometimes she said her head rubbed against the headboard of her bed when she was asleep. Other times she said the baseball caps she had to wear at her job were too tight. She knew people doubted her stories, especially family members. But she couldn't face telling them what was really happening: She'd been pulling her hair out since she was 12.

Daria had no idea why she pulled her hair. She just knew that she couldn't stop. Many times, she did it without even thinking. Daria's mom noticed her doing it while watching TV. The two of them did some research and learned about a condition that some people have called trichotillomania.

What Is Trichotillomania?

Trichotillomania (pronounced: trik-oh-till-oh-MAY-nee-uh) is an impulse control disorder (ICD) that involves strong urges to pull out one's own hair. An impulse control disorder is a type of psychological condition.

Doctors used to believe trichotillomania was rare. But that thinking is now changing as experts gain a better understanding of the condition and more people come forward for help. Trichotillomania affects more girls than guys. Most people who have it develop it during adolescence. But trichotillomania can start in kids as young as 1 year old.

What Happens With Trichotillomania?

People with trichotillomania pull hair out at the root from places like the scalp, eyebrows, eyelashes, or pubic area. Some people pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows. Other people pull out their hair one strand at a time. Some inspect the strand after pulling it out or play with the hair after it's been pulled. About half of people with the condition put the hair in their mouths after pulling it. Some people are very aware of their pulling; others seem to do it without really noticing what they're doing.

It might be hard to understand why some people would pull their own hair or eyelashes out — or why they wouldn't just stop. But trichotillomania isn't just an ordinary habit that a person can easily stop.

Trichotillomania is a type of compulsive behavior. This means that people with the condition feel an overwhelming urge to pull their hair. They also may have other compulsive habits, such as nail biting or skin picking. Some also have problems like depression, anxiety, or obsessive-compulsive disorder (OCD). Compulsive behaviors like trichotillomania involve brain chemistry and may be genetic (meaning they can sometimes run in families).

People with trichotillomania may feel embarrassment, frustration, shame, or depression about the condition. They may worry about what others will think or say. They may feel nagged by people who don't understand that they're not doing this on purpose. They usually try to hide the behavior from others — even their families. This can make it difficult to get help.

Having trichotillomania can affect how people feel about themselves. Some are self-conscious about how hair pulling affects their appearance. Because of this, they might feel less confident about making friends or dating. Others might feel powerless to control the urge to pull or blame themselves for not being able to stop. Feelings like these can cause a person's self-image to suffer.

Why Do People Pull Their Hair?

Doctors don't know for certain what causes trichotillomania. Some think it could be related to obsessive-compulsive disorder since OCD and trichotillomania both involve repetitive behaviors.

Experts think that compulsive behaviors like hair pulling may be caused by an imbalance in the brain’s chemistry. A type of brain chemical, called neurotransmitters, is a normal part of the brain's communication center. When something interferes with how neurotransmitters work, it can cause problems like compulsive or repetitive behaviors.

Some people with trichotillomania say that they notice sensations in their scalp or skin. For example, it may be a tingling feeling that can only be relieved by pulling, like the feeling of relief that comes from scratching an itch. Some people say that they notice a satisfying feeling when they pull their hair. Others don't even notice when they pull and do it without thinking.

Any relief that comes with hair pulling usually only lasts for a moment. The urge almost always returns. That's because when the mind becomes used to giving in to the powerful urges that go with compulsive behaviors, the behavior is reinforced, and then becomes a habit. The mind gets trapped in a cycle of expecting to have the urge satisfied. The longer this goes on, the harder it can become to resist the urge.

How Do People Overcome It?

Because trichotillomania is a biological brain condition, it's not something that most people who have it can just stop doing when they feel like it. They usually need help from medical and behavioral specialists before they can stop. With the right help, though, most overcome their hair-pulling urges. When someone is able to stop pulling, hair usually grows back.

Overcoming hair-pulling urges may involve a specific type of talk therapy called CBT (cognitive behavioral therapy), medication, or a combination of both.

Therapists teach people with trichotillomania special behavior techniques that help them to recognize the urge to pull hair before it becomes too strong to resist. This can involve learning to identify situations, places, or times that have become connected with the behavior and that act as triggers for it. The person learns ways to change or eliminate these triggers. This can then help someone resist the urges so that they eventually grow weaker and then go away.

To gather the information necessary to do this, a therapist will usually recommend keeping a record or diary of pulling episodes. A therapist also can help people to regain confidence and feel better about themselves.

Because the urges and habits that lead to hair pulling are so strong, someone may feel more tension or anxiety when first trying to resist the urge. That's why it helps to work with an expert who can offer support and practical advice about how to reverse these powerful influences.

After starting with therapy, doctors can prescribe medication if extra help is needed. Some medications can help the brain deal better with urges, making them easier to resist. Many people find it helpful to keep their hands busy with a different activity (like squeezing a stress ball, handling textured objects, or drawing) during times or activities when a pulling urge is the strongest. Daria found that knitting while watching TV helped keep her hands busy at a time when she might feel the urge to pull her hair.

Homework time was harder, though. Daria realized that she tended to pull more as she did her homework — partly because she worried about doing well on a project or test, and partly because she tended to pull more when she sat in one place for long periods of time.

Daria and her therapist talked about ways to deal with homework stress. She discovered that being a perfectionist was adding to her tension. Her therapist helped her to see that she could still do good work without it having to be perfect.

As she began to feel more relaxed — and still do excellent work — Daria's confidence grew. She also found it helpful to take breaks during her homework sessions. Getting up and moving around for a few minutes seemed to help.

If you're worried about hair pulling, talk to a parent, school counselor, or someone you trust about getting help overcoming the problem.

Reviewed by: Richard S. Kingsley, MD
Date reviewed: March 2013