Trichotillomania: causes and treatments

Trichotillomania is a disorder characterised by an irresistible and recurrent urge to pull out one's own hair, often leading to significant hair loss and distress. Linked to anxiety and stress, it oscillates between a sporadic gesture and a constant struggle against compulsive urges. Let's explore the multifactorial origins of trichotillomania, and the effectiveness of the various treatment methods.

What is trichotillomania?

The trichotillomania also known as hair-pulling disorder, is a psychiatric disorder characterised by a recurrent, hard-to-control impulse to pull out one's own hair or eyelashes. 

This compulsive behaviour can lead to hair loss or visible hair, often accompanied by bald spots, from scars and a alteration of physical appearance.

Impulse control disorder

Trichotillomania is classified as a impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, revised by the American Psychiatric Association (APA)). It can have a significant impact on the quality of life of sufferers, affecting their self-esteem, body image and social interactions.

It is estimated that trichotillomania affects approximately 1 to 2 % of the French population. However, it is important to note that many cases remain undiagnosed due to the stigma associated with the disorder and the fact that sufferers may conceal their behaviour. Approximately 90 % of adults with the disease are women.

Good to know: Trichotillomania can occur at any age, but often begins in adolescence.

Trichotillomania: causes and treatments 1

Trichotillomania can occur as early as adolescence

What are the symptoms of trichotillomania?

Trichotillomania is characterised by a set of symptoms and specific behaviours:

  • Recurrent pulling out of hair or body hair: The main symptom of this disorder is the repetitive and compulsive pulling out of hair or eyelashes. People with this disorder find it hard to resist the irresistible urge to pull at their hair.
  • Growing tension : Before engaging in tearing, individuals often experience growing tension or anxiety. This tension is temporarily relieved by the act of plucking.
  • Temporary relief: Pulling out hair or body hair provides temporary relief from the tension or emotional discomfort felt by the individual. However, this relief is often followed by guilt, shame or remorse.
  • Loss of control: People with trichotillomania have difficulty controlling their snatching impulses, even if they want to stop. They often feel powerless in the face of this compulsive behaviour.
  • A preference for certain areas: Affected individuals often have favourite areas where they pull out hair. This may include the scalp, eyebrows, eyelashes, facial hair or other parts of the body.
  • Alteration of appearance : Repeated plucking can lead to bald spots, scarring and a change in physical appearance, which can have an impact on self-esteem.
  • The impact on daily life : Trichotillomania can disrupt people's daily lives because of the obsession and time devoted to pulling, as well as the physical and emotional consequences.

Trichotillomania is often accompanied by other disorders, such as anxiety, the depression or other impulse control disorders.

How is trichotillomania diagnosed?

The diagnosis is usually made by a mental health professional, such as a psychiatrist, neurologist or psychologist. clinical psychologist or a general practitioner.

It is based on the diagnostic criteria defined in the classification manuals for mental disorders. 

According to the DSM-5-TR, for suffer from trichotillomania, a person must meet specific criteria, including recurrent hair pulling, unsuccessful attempts to stop the behaviour, and significant associated distress.

The healthcare professional must ensure that the symptoms are not due to other medical conditions, such as dermatological problems or medical problems, that could explain the loss of hair. 

In some cases, it may be necessary to work with other health professionals, such as dermatologists, to assess the physical consequences of pulling out hair.

Once the diagnosis has been made, the healthcare professional can develop a treatment plan adapted to the individual's situation.

What are the known risk factors for the development of trichotillomania?

The development of trichotillomania is influenced by several known risk factors. 

  • Genetics : Studies have shown that there is a genetic component in the development of this disorder. Individuals with a family history of impulse control disorders are more likely to develop this disorder.
  • Anxiety: Certain personality traits, such as anxiety, perfectionism, obsessiveness and a tendency to rumination, are associated with an increased risk of developing trichotillomania. 
  • Environmental influences : the chronic stress and major life changes, social pressure or family conflicts can contribute to the development of this disorder.
  • Trauma : Traumatic or stressful events in childhood or adulthood can trigger trichotillomania in some people. The disorder can sometimes be a way of coping with difficult experiences.

Good to know: Abnormalities in brain function, particularly in reward and impulse control circuits, may also contribute to trichotillomania. Variations in neurotransmitters, such as serotonin, have also been studied in this context.

What are the consequences of trichotillomania for hair?

The effects on the hair can vary depending on the intensity and duration of the behaviour. Repeated hair-pulling can lead to sparse areas or bald plates on the scalp. 

If the hair is constantly pulled with force, this can damage the hair follicle and, in extreme cases, lead to a permanent hair loss.

The act of pulling out your hair can lead to infections and skin disorders, including scars or changes in the texture of the skin on the scalp.

Trichotillomania: does hair grow back?

Hair can grow back if the follicle is not severely damaged, but this can be a serious problem. slow process and the new hair may be finer or have a different texture. 

In cases of severe and and trichotillomania It is possible that the follicles are so badly damaged that regrowth is impossible.

How is trichotillomania treated?

Different methods can be adopted to treat this disorder, depending on individual needs.

Behavioural and cognitive therapy (CBT)

The cognitive and behaviour therapy and psychotherapy which aims to help people understand and change negative or destructive patterns of thought and behaviour. In the context of trichotillomania, CBT is often considered to be one of the most effective treatment methods. 

Patients are gradually exposed to the triggers of hair pulling in a safe and controlled environment, while learning to resist the urge to pull their hair out. 

The CBT sessions are generally structured and take place over a set period of time. They can be carried out individually or in groups.


Certain medications may be prescribed to help manage the symptoms of trichotillomania. Selective serotonin reuptake (SSRIs) are often used to treat the symptoms of anxiety and depression associated with this disorder. 

The use of medicines must be supervised by a qualified healthcare professional who can assess the potential benefits and risks for each patient.

Relaxation techniques

Activities such as meditation, the yoga, or the practising deep breathing are often recommended as part of the treatment for trichotillomania, as they help to reduce the stress and anxiety that can trigger the urge to pull out hair.

The effectiveness of these techniques can vary from person to person, and it can be useful to try them out with the help of a health professional to determine which are most beneficial.

Trichotillomania is a complex disorder that requires special diversified therapeutic strategy and individualised. Combined approaches, including cognitive behavioural therapy, psychotherapeutic appropriate drug treatments, and relaxation techniques, are crucial in helping individuals to fight the urge to pull out their hair. 

Trichotillomania: causes and treatments 2

Several methods can be used to treat trichotillomania: relaxation and medication, for example.

Trichotillomania: causes and treatments 3

Finally, a hair diagnosis performed can provide valuable information about the condition of the hair follicles and treatments to encourage hair regrowth in people with trichotillomania. 

Jean-François Cabos

Jean-François Cabos is the creator of a unique hair care method based on the research he coordinated, which led to the publication of the book "Cheveux, Racines de Vie" with Hélène Clauderer by Robert Laffont (Collection "Réponses/ Santé").

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