Hair Pulling Disorder

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KEY POINTS

• Hair pulling disorder involves repeatedly pulling out hair from the scalp, eyelashes, eyebrows, or other parts of the body.
• Treatment may include therapy, medicine, or habit reversal training.

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What is hair pulling disorder?

Hair pulling disorder involves repeatedly pulling out hair from the scalp, eyelashes, eyebrows, or other parts of the body. It is also called trichotillomania.

What is the cause?

The exact cause of this disorder is not known. People often start hair pulling around the ages of 12 or 13. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Stress plays a part. You may be at higher risk due to problems such as abuse, money problems, or the death of a loved one.
• Your risk is higher if someone in your family has this disorder or obsessive-compulsive disorder.

What are the symptoms?

Symptoms may include:

• Constant tugging and twisting of hair
• Repeatedly pulling enough hair over a long enough period of time to cause hair loss, thinning, or bald spots on the head, or missing eyelashes, eyebrows, or other body hair.
• Repeatedly trying to stop hair pulling
• Feeling very tense right before pulling out the hair or if they try to resist the urge to pull hair
• Feeling pleasure or relief when pulling out the hair
• Denying that they are pulling hair or pulling hair in secret

How is it diagnosed?

Your healthcare provider or therapist will ask about your symptoms, medical and family history, and any medicines you are taking. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

Several types of medicines can help. Your healthcare provider will work with you to select the best medicine. You may need to take more than one type of medicine.

Cognitive behavioral therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new ways to think and act.

Acceptance and commitment therapy (ACT) helps you accept that you can have thoughts and feelings without acting on them. It also helps you learn ways to make changes and stick to your goals.

Habit reversal training helps you become aware of when you're about to pull hair. Then you come up with what is called a competing response. This means that, for example, when you feel like you need to pull hair, you would make a fist and keep your hand in your lap instead.

How can I take care of myself?

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Avoid alcohol and drugs. Exercise according to your healthcare provider's instructions.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

Get emergency care if you or a loved one has serious thoughts of suicide or self-harm, violence, or harming others.