Trichotillomania: Hair Pulling Disorder. What you should know?

a person pulling her hair as she is suffering from trichotillomania - a hair pulling disorder

Defining the problem.

Trichotillomania (TTM) is a psychocutaneous disorder characterized by the repetitive act of hair pulling causing hair loss. The diagnosis has recently been called ‘Hair Pulling Disorder’. The diagnosis is usually psychological distress and the onset is usually early phases of teen or youth. It is usually kept hidden from others and even those closest to the person, like family or friends won’t know about this unless they pay close attention.

Percentage of cases and Onset of disease.

In all of the hair loss cases, the actual percentage of Trichotillomania is between 0.6% to 3.4% and a higher number of cases are noted to be women. The mean age of onset is between 9 to 13 years. The scalp is the most commonly described site but multiple sites like eyebrows, eyelashes, face, limbs, pubic area, underarms, and chest hair can also be involved.


A hair scan or Trichoscopy shows definitive features in TTM like flame hair, broken hair at different lengths, perifollicular hemorrhage, broomstick hair, etc. When the clinical and trichoscopy diagnosis is challenging, biopsy and histologic examination can be considered. The differential diagnosis includes alopecia areata, tinea capitis, traction alopecia, loose anagen syndrome, and secondary syphilis.


Severe Anxiety, major depression, substance abuse, eating disorders, post-traumatic stress disorder (PTSD), personality disorders, OCD and BDD. All of these are on the psychological level and can cause huge concern. Trichotillomania is likely to be the result of the interaction of several factors on a single patient (genetic, psychological, social and neurobiological). A significant association of traumatic childhood events such as emotional neglect, abuse, extreme violence, and sexual harassment is observed.

Treatment options

There are several treatment options:

1. A comprehensive evaluation of individuals with TTM must be conducted by a physician trained in the field of trichopsychodermatology. A detailed past medical history and history of trauma helps in the management. In this interdisciplinary approach, a doctor has to both care for both the hair loss and also to minimize the hair-pulling.

2. In the case it doesn’t work, a psychologist should be consulted and s/he should if it is needed should give the required medications.

3. Doctors should ask the family and friends to be close to the person with this issue and should also be ready in case one requires then someone to talk to. This condition usually affects when the person is alone and goes through severe bouts of loneliness. The presence of family and friends will cause them to be composed and also give the added boost of confidence.

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