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Learn about what is trichotillomania, its causes, and its treatment all in one guide. Discover trichotillomania causes.

Sep 20, 2023 By Madison Evans

Trichotillomania (TTM), often known as hair-pulling disorder, is a complicated neuropsychiatric disorder that falls under body-focused repetitive behaviors. Rooted deep within impulse control disorders, it involves the recurrent, often irresistible urge to pull out one’s hair from the scalp, eyebrows, eyelashes, or other body parts, resulting in noticeable hair loss.

What Is Trichotillomania?

The Cycle: Before hair-pulling, individuals often report an increasing sense of unease, pressure, or stress. It's as if the hair symbolizes anxiety, demanding removal. The relief is almost palpable when the hair is finally tugged out, a brief respite from overwhelming feelings. But this fleeting moment of satisfaction is, unfortunately, short-lived.

A cascade of emotions such as guilt, shame, and self-reproach often follows, further anchoring the vicious cycle. This pattern underpins the cyclical nature of TTM, making it more than just a habit but a compulsive act.

Areas Affected: The breadth of locations impacted by TTM is vast, as it is not constrained to just the scalp. The eyebrows, a significant feature framing the face, are a common target. Similarly, eyelashes, which protect and accentuate the eyes, are frequently pulled, sometimes resulting in their complete absence. The impulse doesn't stop there.

Some individuals report pulling hair from less visible areas, like the arms and legs, or even more private areas, like the pubic region. This variety in affected areas speaks to the profound nature of the compulsion and how it's not merely about visible hair but is tied deeply to the emotional experience.

Physical Repercussions: Beyond the psychological implications, TTM presents undeniable physical consequences. The skin, continually subjected to pulling, can become irritated and red and develop sores or infections from repeated open wounds. An even more alarming physical behavior is trichophagia, where the individual consumes the hair they've pulled out. This act can lead to the formation of hairballs, known as trichobezoars, within the digestive tract.

These hairballs can cause blockages, leading to severe gastrointestinal complications, and may sometimes require surgical intervention.

Trichotillomania Causes and Risk Factors

Identifying the exact etiology of TTM is like piecing together a complex jigsaw puzzle. While the entire picture remains slightly blurry, some pieces offer clarity.

Genetic Factors

Genetics often play a role in predisposing individuals to specific disorders and is one of the main trichotillomania causes. TTM is no exception. Studies have indicated a higher TTM prevalence in individuals with family members with the condition. This familial linkage suggests that genetic markers or mutations might increase one's susceptibility. Though it's not a guarantee that descendants of affected individuals will inherit TTM, the genetic angle is undeniable.

Neurological Considerations

Researchers have found intriguing differences in those with TTM by diving deep into the brain's labyrinth. Specific regions, particularly those connected with habit formation, emotional regulation, and impulse control, like the basal ganglia and frontal lobes, appear to function or communicate distinctively in people with this disorder. These neurological variances might explain why the urge to pull hair is so potent and hard to resist.

Stress and Trauma

Environment and experience heavily influence our behaviors. For many individuals with TTM, hair pulling emerges as a maladaptive coping strategy to handle negative emotions, stress, or past traumatic experiences. It's a physical response to emotional pain, a way to exert control when faced with uncontrollable situations or feelings. This suggests that TTM can sometimes reflect deeper emotional turmoil and not just an isolated impulse control disorder.

Symptoms and Diagnosis

Trichotillomania manifests in various ways, but common symptoms include:

  • Repeated hair pulling, resulting in noticeable hair loss.
  • Tension before pulling or when resisting the urge.
  • Relief or pleasure after hair pulling.
  • Attempts to stop the behavior without success.
  • Concealing hair loss with makeup, hats, or scarves.
  • Social withdrawal or reduced quality of life due to the disorder.

A mental health professional will conduct a thorough clinical evaluation for an accurate diagnosis. It's essential to differentiate TTM from other medical conditions or psychiatric disorders with similar symptoms.

Trichotillomania Treatment Options

Effective trichotillomania treatment involves multidisciplinary care.

Cognitive behavioral therapy (CBT) such as Habit Reversal Training (HRT) is a potential TTM treatment. We identify triggers, introduce competing acts, and raise awareness. Moreover, several drugs have shown promise in treating TTM. However, none are FDA-approved. Antidepressants, notably SSRIs, have had mixed results.

Furthermore, sharing experiences and coping methods in support groups can be beneficial. The Trichotillomania Learning Center (TLC) helps identify support groups. Lastly, meditation, deep breathing, and yoga may aid impulse control and help with this condition.

What Is Life Like with Trichotillomania?

Daily life for individuals with Trichotillomania (TTM) is a monument to tenacity, adaptation, and the human spirit. Though punctuated with challenges, the journey offers opportunities for growth, understanding, and healing. Let’s delve into some practical strategies that individuals have embraced on their paths to living more harmoniously with TTM:


Acceptance is not about resignation but acknowledgment and empowerment. For someone with TTM, coming to terms with their condition can be emotionally charged. Society often stigmatizes conditions it doesn’t understand, adding to the burden. Recognizing and accepting TTM can pave the way for constructive action. Individuals can shift from passive suffering to active coping by identifying and naming the disorder. Avoiding denial and embracing the situation often propels one towards therapeutic solutions, making them more receptive to interventions and treatments.

Cover-up Techniques

The visible consequences of TTM, like bald patches or missing eyebrows, often weigh heavily on an individual’s self-image and esteem. In a world where appearance often dictates first impressions, finding ways to conceal these physical manifestations can boost confidence. Wigs, available in various styles and colors, can help mask hair loss on the scalp. For some, they become an expression of personality and style. Makeup, especially eyebrow pencils or eyeliners, can fill in missing patches or enhance diminished features. Apart from being fashionable accessories, hats, scarves, or bandanas can also serve as protective shields, both physically and emotionally.

Stay Connected

Human connection, a deep-rooted evolutionary need, becomes even more critical during challenging times. For someone with TTM, the impulse might be to retreat, to isolate oneself for fear of judgment or misunderstanding. However, maintaining strong bonds with friends, family, or supportive communities can be incredibly healing. These relationships serve as anchors, providing emotional ballast during stormy times. By sharing their experiences and feelings with trusted individuals, those with TTM can feel understood, validated, and less alone. Moreover, supportive loved ones can offer perspective, encouragement, and sometimes even aid in recognizing triggers or patterns.

Seek Education

Knowledge, as they say, is power. The more one understands TTM, its causes, manifestations, and management strategies, the better they can navigate its challenges. Individuals can demystify the disorder by going into scientific literature, joining support groups, attending workshops, or consulting experts.


With understanding, acceptance, and the right interventions, individuals with TTM can lead fulfilling, productive lives. Society must approach this disorder with empathy and openness, ensuring those affected receive the support and respect they deserve.

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