Trichotillomania (hair pulling disorder)

Trichotillomania, also known as trich or TTM, is when someone cannot resist the urge to pull out their hair.

They may pull out the hair on their head or in other places, such as their eyebrows or eyelashes.

Trich usually starts between the ages of 10 and 13 years old.

Symptoms of trichotillomania

People with trich feel an intense urge to pull their hair out and they experience growing tension until they do. After pulling their hair out, they feel a sense of relief.

A person may sometimes pull their hair out in response to a stressful situation, or it may be done without really thinking about it.

Most people with trich pull out hair from their scalp, but some pull out hair from other areas, such as their:

• eyebrows
• eyelashes
• genital area
• beard or moustache

Bald patches on the head may have an unusual shape and affect 1 side of the head more than the other.

Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves.

Causes of trichotillomania

It's not entirely clear what causes trich. It could be:

• your way of dealing with stress or anxiety
• a chemical imbalance in the brain
• changes in hormone levels during puberty
• genetic - more than one person in a family may have the condition

For some people, hair pulling can be a habit that's hard to break. The more they pull their hair out, the more they want to keep doing it.

When to see a GP

See your GP if you're pulling your hair out or if you notice that your child is.

You should also see your GP if you or your child has a habit of eating hair. This can cause hairballs to form in the stomach, leading to serious illness.

Your GP may examine areas where the hair is missing to check that nothing else is causing the hair to come out, such as a skin infection.

If your GP thinks you have trich, you may be referred for a type of treatment called cognitive behavioural therapy (CBT).

If you are under 18, this may be offered through your local children and young people's mental health services.

Treating trichotillomania

Trich is commonly treated using a type of CBT called habit reversal training.

This aims to help you replace a bad habit with something that's not harmful. Treatment usually involves:

• keeping a diary of your hair pulling
• working out the triggers for your hair pulling and learning how to avoid them
• replacing hair pulling with another action, like squeezing a stress ball
• loved ones providing emotional support and encouragement

Antidepressants are not usually prescribed to treat trich.

Things you can try yourself

Here are some tips from people with trich that may help when you feel the urge to pull your hair:

• squeeze a stress ball or something similar
• form a ball with your fist and tighten the muscles in that arm
• use a fidget toy
• wear a bandana or a tight-fitting hat, such as a beanie
• take a soothing bath to ease any stress or anxiety
• practise deep breathing until the urge to pull goes away
• exercise
• put plasters on your fingertips
• cut your hair short

Getting support

It may also help to open up about your trich to people you trust, as hiding it can sometimes make your anxiety worse.

Many people who have learned to manage their trich say that speaking to others about the condition led to a reduction in hair pulling.

There is information on treatments and self-help advice on the OCD UK website.