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Trichotillomania (TTM), also known as trich, is when someone can’t resist the urge to pull out their hair. It is an impulse control disorder. It is estimated to affect one to four percent of people. More common in teenagers and young adults it tends to affect girls more often than boys. People with trichotillomania 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. Most people with trichotillomania pull out hair from their scalp, but some pull out hair from other areas, such as their eyebrows, eyelashes or less commonly the genital and other areas. Trich may cause feelings of shame and low self-esteem. Those affected may try to keep their condition to themselves. Which can prove difficult when bald patches appear. People who suffer from trichotillomania often pull only one hair at a time and these hair-pulling episodes can last for hours. Trichotillomania can come and go, the person may not have the urge to “pull” for days, weeks, months, and even years.

Automatic or focused

Trichotillomania is “automatic” or “focused” hair pulling. If you are aware that you are pulling you hair it is “focused”. If you are unaware it is considered “automatic”. Some people have been seen to pull their hair out while asleep. Which is an example of “automatic” trichotillomania, called sleep-isolated trichotillomania. You may have either “automatic” or “focused” trichotillomania and can also have both.

What causes Trichotillomania?

No one knows what causes it. Most likely it can the result of many different causes. Stress seems to be connected to the condition. And it occurs more commonly in those with obsessive compulsive disorder, anxiety and depression. Trichotillomania also has a high overlap with post-traumatic stress disorder. Hair pulling can be addictive or negatively reinforcing, as it is associated with rising tension beforehand and relief afterward. The feeling of relief afterwards drives people to keep pulling.

Hair Loss


Treatment is based on a person’s age. Most pre-school age children outgrow the condition if it is managed. In young adults, establishing the raising awareness of the condition is an important reassurance. Behaviour modification programs, may be considered; Habit reversal training (HRT) and hypnotherapy. But drugs are no longer considered useful.

When trichotillomania begins in adulthood, it is often associated with other mental disorders. The hair pulling may resolve when other conditions are treated.

Likely Outcome

If it started before the age of five the condition will typically limit itself and there’s no need to do anything. Trichotillomania starting for the first time in adults may be a result of something else. Another mental health issue that causes the condition. Or it could be something from the person’s past. Treating this underlying condition will aid the trichotillomania.
Infections may occur due to picking and scratching, but other complications are rare. People often find that support groups are helpful in living with and overcoming the disorder.


Trichotillomania Support UK:

Trichotillomania Learning Center:

MIND – Understanding OCD:

OCD Action:


Anxiety UK

Anxiety Alliance

No Panic

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