Trichotillomania, also known as hair-pulling disorder or trich, is characterized by repeated and persistent urges to pull hair from the body. This behavior could be targeted anywhere that hair grows, such as the head, chest, pubic area, eyebrows, and eyelashes. The pulling results in significant hair loss and distress in social and professional areas of life.
While not a rare disorder, there are many trichotillomania misconceptions. These misconceptions or trichotillomania myths can cause embarrassment to those with the disorder and lead to further stigmas surrounding this disorder. Understanding trichotillomania starts with learning the facts.
Myth #1: Trichotillomania is a rare disorder
Fact: Trichotillomania is more common than you may think.
Doctor’s don’t know the true prevalence of trichotillomania. While no nationwide studies have been performed, some researchers estimate the lifetime trichotillomania prevalence rate to be between 0.5% and 2.0% in America. Those estimates reveal that as many as 13 million people in the U.S. could have this disorder at any given time. If that’s the case, why do some people mistakenly view it as rare?
One reason that this disorder may be viewed as rare is that people who struggle with it simply don’t like to talk about it. The inability to control the urge to pull out one’s hair with resultant bald spots can be a source of embarrassment and shame. With modern society’s focus on beauty, hair loss is viewed as undesirable. Low-self esteem, social dysfunction, and social anxiety have all been associated with trichotillomania and the inability to stop pulling hair.
Trichotillomania statistics reveal that the most common site for pulling is the scalp (72.8%), followed by the eyebrows (56.4%) and the pubic region (50.7%). Hair pulling can be focused or automatic. Focused pulling can occur when a person feels or sees a hair that is irregular, coarse or viewed as out of place. Automatic pulling occurs without the person being fully aware that they are pulling hair.
Myth #2: Only women have trichotillomania
Fact: Trichotillomania is present in men, too.
Trichotillomania appears to occur at the same rate in boys and girls during childhood. Most people with trichotillomania begin hair pulling in childhood. However, studies show that in adulthood, trichotillomania is seen more often in women than in men, with a ratio of 4 to 1 and sometimes even higher. It is thought that the stigma of the disorder keeps many individuals, especially men, from seeking treatment. The apparent lack of men with trichotillomania may be a reflection of the disorder being under-diagnosed or under-reported.
Women with trichotillomania may find it harder to hide bald spots, even with the use of wigs and false eyelashes. In comparison, balding is expected to occur in men as they age and men with trichotillomania may find it easier to hide hair pulling by shaving their head or beard.
Though the prevalence of trichotillomania in men remains unknown, The National Organization for Rare Disorders states that the majority of people will never receive appropriate treatment for this disorder. The range of time a person struggles with trichotillomania can be several months or upward of 20 years.
Myth #3: Hair pulling is relatively harmless
Fact: Hair pulling can cause real physical and emotional harm.
From an outside perspective, trichotillomania may not seem very serious and more like a harmless habit. The truth is, the side effects of trichotillomania can be severe and impact an individual’s daily life.
The emotional toll can be seen in lowered social activity and increased social anxiety. Afraid that they will be found out or that someone will notice their hair pulling, some people may purposely isolate themselves. Almost one-third of adults with trichotillomania report a low or very low quality of life.
Some individuals with trichotillomania may ingest their hair, which is known as trichophagy or trichophagia. If large amounts of hair are regularly ingested, it could lead to the formation of hair build-up in the intestines, known as trichobezoar. Trichobezoar causes abdominal pain, anemia, nausea, vomiting and possibly a bowel obstruction that might require surgery.
Myth #4: Your hair will always grow back
Fact: Trichotillomania can cause permanent hair loss.
Constant and persistent hair pulling can compromise the skin, leading to inflammation and possible infections. One common symptom is damaged hair follicles with broken hair shafts that remain in the skin, which can lead to pseudofolliculitis (commonly known as razor bumps) that causes itchiness and discomfort. Pseudofolliculitis further leads to more hair pulling and scratching.
Once an infection has been introduced, the likelihood of it spreading increases if the hair pulling continues, because pores and compromised skin is left open to infection. Infections caused by hair pulling, scratching or picking at the skin can lead to scarring and affect long-term hair growth.
Regrowing hair after trichotillomania is possible. One study showed that treatment of topical steroids, anti-itch shampoo and antibiotics can alleviate immediate discomfort experienced from hair pulling and subsequently allow time for re-growth.
Myth #5: Trichotillomania is a form of self-harm
Fact: Trichotillomania is a compulsive behavior, not a form of self-harm.
Pulling hair, among other actions, can be a type of self-harm. However, this type of hair pulling can be differentiated from trichotillomania based on the motivation behind the behavior. Self-harm is used to cope with intense or uncomfortable feelings. Trichotillomania, on the other hand, is a compulsive behavior and is not the same as self-harm.
Trichotillomania can be caused by various reasons, both negative and neutral. Hair pulling can be a way to relieve tension and stress. It can also be brought on without a person realizing they are hair pulling, such as when an individual is bored or watching television. Much different than self-harm, trichotillomania is not done with the intent to cope with negative feelings.
Negative emotions that may trigger trichotillomania can include:
People with trichotillomania often report feelings of relief or satisfaction after hair pulling. These positive feelings are often the motivation to continue hair pulling. However, the feelings are often short-lived, as most people report feeling ashamed after hair pulling.
Myth #6: Trichotillomania is the result of trauma
Fact: The exact cause of trichotillomania is unknown.
While early research on trichotillomania suggested that it stemmed from childhood trauma, there is little evidence to suggest that this fact is true. The modern explanation for trichotillomania suggests that it results from several factors, including genetic and environmental factors.
Family studies reveal that there are increased rates of trichotillomania seen among first-degree relatives, though this fact is not a guarantee that the disorder will occur. One theory is that hair pulling helps regulate emotional or stressful events by providing an escape or temporary relief from negative emotions.
Several brain studies have been performed to note any structural brain changes in those with trichotillomania. Some findings include subtle changes in areas of the brain that affect the development of certain habits and behaviors.
Myth #7: People with trichotillomania can just stop
Fact: Trichotillomania is not a habit to be overcome. It is a mental health disorder.
Sometimes family or friends with good intentions may offer the advice of, “Just stop pulling,” and, “It will get better.” Or, they may police someone with trichotillomania when the hair pulling is evident. However, these statements may be ineffective at best and harmful at worst, because trichotillomania is not something someone can just stop doing without professional help.
Trichotillomania is a mental health disorder, not a bad habit. The stigma and negative feelings that surround this condition may turn someone away from treatment before they even have a chance to reach out. Treatment for trichotillomania is necessary for recovery. One study noted that early diagnosis and appropriate treatment resulted in symptom reduction in at least 50% of individuals with trichotillomania.
One of the top treatments for trichotillomania is a form of psychotherapy known as habit reversal therapy (HRT). Some main features of HRT include:
- Self-monitoring and tracking of hair pulling
- Awareness training
- Environment modification to reduce hair pulling
To improve the quality of life, prevent serious medical complications and improve psychosocial function in those with trichotillomania, treatment is necessary.
It is possible to get help for trichotillomania, and help someone else, too. If you or someone you know is struggling with drug or alcohol addiction and co-occurring trichotillomania, give us a call at The Recovery Village. One of our representatives can discuss an appropriate treatment plan for you.
Grant, Jon E.; Chamberlain, Samuel R. “Trichotillomania.” The American Journal of Psychiatry, September 1, 2016. Accessed June 11, 2019. Panza, Kaitlyn E.; Pittenger, Christopher; Bloch, Michael H. “Age and Gender Correlates of Pulling in Pediatric Trichotillomania.” Journal of the American Academy of Child & Adolescent Psychiatry, March 2003. Accessed June 11, 2019. Pereyra, Aubree D.; Saadababi, Abdolreza. “Trichotillomania.” StatPearls Publishing, January 2019. Accessed June 11, 2019. National Organization for Rare Disorders, Inc. “Trichotillomania.” 2017. Accessed June 11, 2019. Bottesi, Gioia; Cerea, Silvia; Razzetti, Enrico; Sica, Claudio; Frost, Randy O.; Ghisi, Marta. “Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample.” Frontiers in Psychology, February 25, 2016. Accessed June 11, 2019. Oon, Hazel H; Lee, Joyce SS. “Treatment of Pseudofolliculitis in Trichotillomania improves Outcome.” International Journal of Trichology, July-December 2011. Accessed June 11, 2019.
Grant, Jon E.; Chamberlain, Samuel R. “Trichotillomania.” The American Journal of Psychiatry, September 1, 2016. Accessed June 11, 2019.
Panza, Kaitlyn E.; Pittenger, Christopher; Bloch, Michael H. “Age and Gender Correlates of Pulling in Pediatric Trichotillomania.” Journal of the American Academy of Child & Adolescent Psychiatry, March 2003. Accessed June 11, 2019.
Pereyra, Aubree D.; Saadababi, Abdolreza. “Trichotillomania.” StatPearls Publishing, January 2019. Accessed June 11, 2019.
National Organization for Rare Disorders, Inc. “Trichotillomania.” 2017. Accessed June 11, 2019.
Bottesi, Gioia; Cerea, Silvia; Razzetti, Enrico; Sica, Claudio; Frost, Randy O.; Ghisi, Marta. “Investigation of the Phenomenological and Psychopathological Features of Trichotillomania in an Italian Sample.” Frontiers in Psychology, February 25, 2016. Accessed June 11, 2019.
Oon, Hazel H; Lee, Joyce SS. “Treatment of Pseudofolliculitis in Trichotillomania improves Outcome.” International Journal of Trichology, July-December 2011. Accessed June 11, 2019.