Hair pulling (trichotillomania)

What is trichotillomania?

Trichotillomania is defined by some people as an impulse-control disorder and by others as a type of obsessive-compulsive disorder.

Although it's defined as a psychological problem, research has shown that - apart from their habit - people with trichotillomania have a healthy psyche. But it can sometimes be associated with depression, anxiety and other problems.

Trichotillomania affects at least 2 per cent of the population - and mostly starts around puberty or early adulthood. The person usually pulls out hair from the scalp or face (eyelashes or eyebrows) because it's easily accessible, but may pull out body hair, too.

Causes and risk factors

The cause of trichotillomania isn't known. Most experts believe it's a type of obsessive-compulsive disorder, but there may be a hereditary element. Some blame environmental pollution, streptococcal infections, or even deficiencies of brain or body chemicals and nutrients.

The answer probably lies somewhere between pleasant habit and a reaction to stress, at least in terms of the initial trigger. People often start by pulling out damaged hairs to relieve an itch or a follicle, but as the habit progresses they may lose any reason for it.

Treatment and recovery

Like other anxiety and compulsive problems, cognitive behavioural therapy (CBT) can be very effective in treating trichotillomania. The two elements of this treatment are learning about the condition and what triggers it, and behavioural changes to avoid the hair-pulling, such as distraction strategies.

Drug treatments can also help, especially in combination with CBT and when associated problems such as depression are present. But drugs should be viewed as a temporary measure while the person gets on top of the problem. If drugs alone are used, the symptoms often return once they're stopped.

Some people have used hypnosis, biofeedback, diet and other strategies, so these may be worth trying.