My watch list  


Classification & external resources
ICD-10 F63.3
ICD-9 312.39
DiseasesDB 29681
MedlinePlus 001517
eMedicine derm/433  ped/2298

Trichotillomania (TTM), or "trich" as it is commonly known, is an impulse control disorder characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV as an impulse control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Due to social implications the disorder is often unreported and it is difficult to accurately predict prevalence of trichotillomania; 2.5 million in the U.S. may have TTM, with a 1% prevalence rate.[1]

TTM seems to strike most frequently in the pre- or early adolescent years. The typical first-time hair puller is 12 years old, although TTM has affected people as young as one and as old as seventy. It is thought that ninety percent of those with TTM are women, but research is inconclusive and it may simply be the case that men are less likely to seek treatment and can more easily hide their symptoms. A form of TTM that affects very young children appears to occur in males and females at an equal rate and seems to be more benign in nature.

The name derives from Greek tricho- (hair) plus mania.



Individuals with trichotillomania can live relatively normal lives; however, they may have bald spots on their head, among their eyelashes, pubic hair, or brows. An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as 'pulling') whatsoever. This 'pulling' often resumes upon leaving this environment.[2]

Many clinicians classify TTM as a habit behavior, in the same family as nail biting (onychophagia) or compulsive skin picking (dermatillomania). These disorders are a cross between mental disorders, such as obsessive compulsive disorder (OCD) because the sight or feel of a body part causes the individual anxiety, and physical disorders such as stereotypic movement disorder because the person performs repetitive movements without being bothered by or completely aware of them. The current classification of trich as an impulse disorder with pyromania, pathological gambling and kleptomania, has been called into question as inadequate and in need of revision.[3] One study showed that individuals with TTM have decreased cerebellar volume.[4] Like people with other OCD-related disorders (for example, body dysmorphic disorder, impulse control disorder, kleptomania, Tourette syndrome), people with TTM have a reduced ability to transport serotonin at the presynaptic level.[5] Anxiety, depression and OCD are more frequently encountered in people with TTM.[6] People with TTM may also eat/chew the roots of the hair that they pull, referred to as trichophagia. In extreme cases this can lead to Rapunzel syndrome, and even death.[7][8][9] Some individuals with TTM may feel they are the only person with this problem due to low rates of reportage.[10]


Trichotillomania is a chronic problem; although one can recover from it, there is currently no specific cure, although OCD medications are highly effective.[citation needed] It can be stubborn, but with proper treatment and persistence, picking and/or pulling hairs can be greatly reduced and even brought under control (often called "hibernation").

Habit Reversal Training or HRT, has been shown to be a successful adjunct to pharmacotherapy as a way to treat TTM.[11] Many patients who pull their hair don’t realize that they are doing this; it is a conditioned response.[citation needed] With Habit Reversal Training, doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. As a part of the behavioral record-keeping component of HRT, patients are often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes.

Selective serotonin reuptake inhibitors are effective in the treatment of obsessive-compulsive disorder and are commonly used in the treatment of trichotillomania. Clomipramine treatment was shown to significantly improve symptoms when tested in a doubled-blind study.[12]

Fluoxetine and other similar drugs have limited usefulness in treating TTM, and can often have significant side effects.[13] According to F. Penzel, antidepressants can even increase the severity of the TTM.[3]


Sixty-five percent of those afflicted are female.[10] Evidence now points to a genetic predisposition.[14][15]

The number of reported trichotillomania cases has increased throughout the years, possibly due to a reduced stigma around the condition. Estimates of the number of persons with TTM range from 1–3%[16] up to 5%[15] of the world's population. This prevalence data is based on the DSM-IV criteria which include reported increased tension preceding, and relief following, pulling, which has found to be inapplicable in some cases. Without the presence of these criteria the prevalence is much higher.[citation needed]

See also


  1. ^ Diefenbach, G.J., Reitman, D. & Williamson, D.A., (2000). "Trichotillomania: A challenge to research and practice.". Clinical Psychology Review (20): 289–309.
  2. ^ Christenson GA, Mackenzie TB, Mitchell JE (1991). "Characteristics of 60 adult chronic hair pullers". The American journal of psychiatry 148 (3): 365–70. PMID 1992841.
  3. ^ a b Penzel (2003) The Hair-Pulling Problem: A Complete Guide to Trichotillomania; Oxford University Press, p. 3. ISBN 0-19-514942-4
  4. ^ Keuthen NJ, Makris N, Schlerf JE, et al (2007). "Evidence for reduced cerebellar volumes in trichotillomania". Biol. Psychiatry 61 (3): 374–81. doi:10.1016/j.biopsych.2006.06.013. PMID 16945351.
  5. ^ Marazziti D, Dell'Osso L, Presta S, et al (1999). "Platelet [3H]paroxetine binding in patients with OCD-related disorders". Psychiatry research 89 (3): 223–8. PMID 10708268.
  6. ^ Christenson GA, Crow SJ (1996). "The characterization and treatment of trichotillomania". The Journal of clinical psychiatry 57 Suppl 8: 42–7; discussion 48–9. PMID 8698680. Retrieved on 2007-07-24.
  7. ^ Ventura DE, Herbella FA, Schettini ST, Delmonte C (2005). "Rapunzel syndrome with a fatal outcome in a neglected child". J. Pediatr. Surg. 40 (10): 1665–7. doi:10.1016/j.jpedsurg.2005.06.038. PMID 16227005.
  8. ^ Pul N, Pul M (1996). "The Rapunzel syndrome (trichobezoar) causing gastric perforation in a child: a case report". Eur. J. Pediatr. 155 (1): 18–9. PMID 8750804.
  9. ^ Hairball kills teenager. Retrieved on 2007-08-11.
  10. ^ a b Christenson GA, MacKenzie TB, Mitchell JE (1994). "Adult men and women with trichotillomania. A comparison of male and female characteristics". Psychosomatics 35 (2): 142–9. PMID 8171173.
  11. ^ Woods DW, Wetterneck CT, Flessner CA (2006). "A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania". Behaviour research and therapy 44 (5): 639–56. doi:10.1016/j.brat.2005.05.006. PMID 16039603.
  12. ^ Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL (1989). "A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling)". N. Engl. J. Med. 321 (8): 497–501. PMID 2761586.
  13. ^ Christenson GA, Mackenzie TB, Mitchell JE, Callies AL. (1991). "A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania.". Am J Psychiatry. 148 (11): 1566–71.
  14. ^ Entrez Gene: HOXB8 homeobox B8 [ Homo sapiens ]. National Center for Biotechnology Information (August 12 2006). Retrieved on 2007-11-13.
  15. ^ a b Hair pulling disorder gene found. BBC News (29 September 2006). Retrieved on 2007-05-01.
  16. ^ Christenson GA, Mackenzie TB, Mitchell JE (1991). "Characteristics of 60 adult chronic hair pullers". Am J Psychiatry. 148 (3): 365–70.

Further reading

  • Keuthen, Stein, Christensen & Christenson (2001) Help for Hair Pullers: Understanding and Coping With Trichotillomania; New Harbinger Publications, ISBN 1-57224-232-9
  • Parker (Ed.) (2004) Trichotillomania - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References ; Icon Health Publications, ISBN 0-597-84664-2
  • Stein (Ed.), Christenson (Ed.) & Hollander (Ed.) (1999) Trichotillomania; American Psychiatric Press, ISBN 0-88048-759-3
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Trichotillomania". A list of authors is available in Wikipedia.
Your browser is not current. Microsoft Internet Explorer 6.0 does not support some functions on Chemie.DE