Understanding Trichotillomania: Risk Factors and Treatments


Many of us in western culture associate plentiful hair with youth and beauty. Of course, that means that the 35 million men throughout the U.S. who experience some type of hair loss or baldness often feel pressured to find ways to minimize the extent of their condition. But for women who experience hair loss, the social ramifications can be even more severe. Those women who lose their hair due to chemotherapy treatments might invest in wigs, for example. But what about when hair loss results not from genetics or medical procedures but from anxiety-induced behaviors?

Within a certain capacity, hair loss is normal. On average, people shed 50 to 100 hairs per day. You might start to lose more if you’re battling an illness or if you’re under substantial emotional strain. But while some conditions cause hairs to shed without any physical intervention, there’s another health concern that results in the uncontrollable urge to remove hair from the scalp and other areas of the body. This is a condition known as trichotillomania — and though it affects roughly 3% of the U.S. population, there’s a lot about it that’s misunderstood.

Often shortened to “trich” for convenience, this condition stems from anxiety. It’s characterized by the compulsion to pull out hairs from areas like the head, eyebrows, eyelashes, and more in order to neutralize those feelings of anxiety. In many cases, it can result in substantial hair loss and bald patches. Recent research has suggested that poor emotional control and psychological inflexibility could play a part in this disorder, meaning that adults with trichotillomania may have issues coping with their emotional and thought patterns — and the only way they’re able to deal with these feelings is through compulsive hair pulling.

That said, there’s no definitive cause. One theory is that it’s the result of a chemical messenger disruption between the brain and the nerve cells, while another potential cause might lie in genetic predisposition. In some cases, a major life change or traumatic event could contribute to the development of trichotillomania. For example, a child whose parents have divorced — like the 40% to 50% of partners who choose to dissolve their relationships in the United States — might have a tough time processing these events and may rely on behaviors like these to relieve internal tension. Death, abuse, and even feelings of boredom may also result in the development of this condition. What researchers do know is that individuals diagnosed with trich are between the ages of nine and 13, on average — which means that parents may need to take action if they notice the potential signs in their children. Otherwise, this condition can persist for years.

Although 23% of massage customers decided to undergo this treatment for relaxation and stress reduction between 2013 and 2014, trichotillomania isn’t going to be cured by a quick trip to the spa. Typically, treatment for this condition will involve some kind of behavioral therapy, though there are some medications that may also be used in conjunction with psychological treatment. In therapy, patients learn to identify and resist the urge to pull their hair and may develop a replacement habit to keep them from acting on those urges.

Interestingly, there’s also a new technological product on the market that could help. HabitAware, a tech startup, developed a smart bracelet that can assist users in re-training their brains to resist detrimental behaviors like hair-pulling and nail-biting. Although it’s no replacement for treatment from a medical or mental health professional, it could conceivably assist those who struggle to put what they’ve learned in therapy into action.

Although trichotillomania doesn’t get a lot of attention and is often dismissed in terms of its severity, parents and teens may want to start paying attention. It’s a condition that can be successfully treated but that also has drastic consequences if it’s ignored — and is often a symptom that something bigger is going on.