MedlinePlus Medical Encyclopedia: Trichotillomania

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Trichotillomania

Contents of this page:
Illustrations Alternative names Definition Causes, incidence, and risk factors Symptoms	Signs and tests Treatment Expectations (prognosis) Complications Prevention

Illustrations

Trichotillomania - top of the head

Alternative names Return to top

Compulsive hair pulling

Definition Return to top

Trichotillomania is hair loss caused by compulsive pulling and/or twisting of the hair until it breaks off. The hair may be lost in round patches or diffusely across the scalp. The effect is an uneven appearance. Other hairy areas may be plucked, such as the eyebrows, eyelashes, or body hair.

Causes, incidence, and risk factors Return to top

Trichotillomania is a type of compulsive behavior and its causes are not clearly understood. Symptoms usually begin before the age of 17. It may affect as much as 4% of the population. People with this disorder will often seek the help of a dermatologist initially. Women are 4 times more likely to be affected than men.

Symptoms Return to top

These symptoms are usually seen in children:

constant tugging, pulling, or twisting of hair
increasing sense of tension is present before the hair pulling
sense of relief, pleasure, or gratification is reported after the hair pulling
hair pulling leads to an uneven appearance
bare patches or diffuse loss of hair
hair regrowth in the bare spots that feels like stubble
some individuals may develop a bowel obstruction if they eat the hair they pull out
other self-injury behaviors may be present
people suffering from this disorder often deny pulling out their hair

Signs and tests Return to top

A biopsy may be done to rule out other causes, such as a scalp infection, to explain the hair loss.

Treatment Return to top

No expert consensus exists, however various medications, particularly antidepressants like fluoxetine (Prozac) have been shown effective in reducing symptoms.

Expectations (prognosis) Return to top

Typically, trichotillomania is limited to younger children who tend to outgrow the behavior. For most, the hair pulling is time-limited to 12 months. Early onset (before age 6) is associated with a better prognosis.

Complications Return to top

Complications usually arise when the pulled-out hair is eaten (trichophagia). This can result in intestinal obstruction or lead to malnutrition.

Prevention Return to top

Early detection remains the best form of prevention since it leads to early treatment. Decreasing stress in the environment might be beneficial, as stress may increase compulsive behavior.

Update Date: 5/4/2004

Updated by: Ram Chandran Kalyanam, M.D., Department of Psychiatry, Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, Pittsburgh, PA. Review provided by VeriMed Healthcare Network.

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