Trichotillomania Diagnosis and Treatment

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Trichotillomania, sometimes referred to as TTM or trich, is a disorder in which the affected person repeatedly pulls out hair from any part of the body for non-cosmetic reasons. Owing to the compulsive nature of this behavior, it is classified in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an obsessive-compulsive spectrum disorder.


According to DSM-5, trichotillomania has five distinct characteristics:

  • Recurrent pulling out of one’s hair resulting in noticeable hair loss.
  • An increasing sense of tension immediately prior to pulling out the hair or when attempting to resist the behavior.
  • Pleasure, gratification, or relief when pulling out the hair.
  • The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition such as alopecia areta.
  • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Who Gets Trichotillomania?

Trichotillomania is a relatively rare illness, affecting less than 1% of the population. Trichotillomania can affect people of all ages; however, it appears to be much more common among children and adolescents than adults. It also appears that the nature of trichotillomania depends on the age at which it begins.

Young Children (Less Than 5 Years Old)

In very young children, trichotillomania has been compared to other habits such as thumb sucking or nail-biting. Children less than 5 years old often pull their hair out unknowingly or even while they sleep. In the same way that thumb-sucking stops spontaneously for most children, the majority of children who begin to pull their hair at this early age will stop on their own.

Preadolescents and Young Adults

The most common age for trichotillomania to begin is between 9 and 13 years of age. Interestingly, the majority of people (70% to 90%) affected by trichotillomania at this age are female. Among people whose trichotillomania begins at this age, the disease tends to be chronic in nature. In addition, these individuals often have oral rituals associated with hair pulling, such as chewing or licking the lips or even the eating of hair.


Trichotillomania that occurs for the first time in adults may be secondary to another psychiatric illness. Addressing the main psychiatric illness may bring about an end to the secondary trichotillomania.


Because trichotillomania can resemble other medical conditions associated with hair loss such as alopecia areta, diagnosis of trichotillomania often requires both a dermatological and psychiatric evaluation. Diagnosis may be complicated as alopecia areata itself can sometimes trigger trichotillomania.

In both adolescents and adults, a trichotillomania diagnosis may be further hampered by the person’s reluctance to disclose their hair-pulling behavior.


Treatment of trichotillomania is often unnecessary for very young children as they usually grow out of it. However, for people with adolescent-onset trichotillomania, treatment may be necessary, especially if it is suspected that the individual is consuming their own hair, which can cause dangerous blockages in the gastrointestinal system.

Cognitive behavioral techniques have demonstrated some efficacy in treating trichotillomania. Prominent among these is habit reversal therapy. Habit reversal therapy involves self-monitoring of behaviors, improving stress coping strategies, increasing social support and relaxation therapy.

Currently, there is limited evidence that medications such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) are effective in treating trichotillomania, so the FDA has not approved any medications for treating it.

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  • Bruce, T.O., Barwick, L.W., & Wright, H.H. (2005). “Diagnosis and Management of Trichotillomania in Children and Adolescents” Pediatric Drugs 2005 7: 365-376.
  • Sah, D.E., Koo, J., & Price, V.H. (2008). “Trichotillomania” Dermatologic Therapy 2008 21: 13-21.