It’s not just an expression: For some people, repeatedly pulling their own hair out is an urge they can’t resist. William Wooden, M.D, a plastic surgeon at Indiana University Health, explains what drives the behavior and how it’s treated.For those who have trichotillomania—the medical term for hair-pulling disorder—the condition is a source of intense frustration and shame. The compulsion to pull out their hair can be so extreme that individuals develop embarrassing bald spots they have to hide or explain away, yet they still can’t stop pulling.While the origins of trichotillomania aren’t fully understood, the disorder appears to be triggered by a stressful life event, says Dr. Wooden. “Hair-pulling often begins in childhood and adolescence, so it may be prompted by issues like bullying, moving to a new town, separation or divorce,” he explains.Trichotillomania affects boys and girls equally during childhood, but it’s mostly seen in girls during puberty. Adults struggle with hair pulling as well, but the behavior rarely starts then. “Usually it’s an issue they’ve been dealing with for years,” Dr. Wooden says.Sufferers typically pull hair from their head but may target other spots like their arms, eyebrows, eyelashes, and pubic area. Some have rituals such as examining the hair root, rubbing it against their lips or face, or chewing on it. Others eat the hair—a habit which, performed over a long period of time, may create a hairball that blocks the intestines. Damage to the skin is fairly minor, and the hair usually grows back, though Dr. Wooden says that some people with trichotillomania may suffer from permanent hair loss.
Though the condition can vary in severity, even a seemingly mild case warrants evaluation by a doctor. “Most people with trichotillomania have other psychological issues such as depression or additional body-focused behaviors like thumb-sucking and nail-biting,” Dr. Wooden says.
The behavior is also seen in children with autism, who often engage in similar repetitive behaviors such as bobbing their head and flapping their arms. “Doctors need to identify any underlying illnesses first, and then investigate what may have happened in the person’s life to trigger the disorder,” he explains.
The good news is that trichotillomania is treatable. Non-drug approaches include cognitive behavioral therapy and habit-reversal therapy, which can help patients recognize the thoughts and feelings associated with hair pulling and learn healthier ways to respond when they get the urge to pull.
While no medication has been approved by the FDA to treat trichotillomania, antidepressants such as Prozac and Zoloft and the opioid blocker naltrexone may reduce symptoms in some patients.