What is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania, also known as hair pulling disorder or “trich”, is a disorder involving the repetitive pulling out of one’s own hair, despite multiple attempts to stop or decrease the behavior. It is conceptualized to belong to a collection of behaviors known as body focused repetitive behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in unwanted damage to the body.

Although the severity of hair pulling varies, many individuals with trichotillomania exhibit noticeable hair loss, which they attempt to camouflage. Physical effects of pulling such as pruritus, tissue damage, infection, and repetitive motion injuries to the muscles or joints are not uncommon. Those who ingest pulled hair or parts thereof have the potential to experience gastrointestinal distress or develop a trichobezoar (hair ball in the intestines or stomach), which could lead to gastrointestinal blockage and require surgical removal. Although trichobezoars are rare, they are a serious risk for those who ingest hair.

Individuals who struggle with trichotillomania may experience shame and embarrassment, and as a result, may avoid certain social situations or activities (e.g., outdoor activities, wind, pools, gyms, beaches, physical intimacy), salons, and medical care. The emotional impact of the disorder can lead to painful isolation and emotional distress, placing them at risk for co-occurring mood or anxiety disorders.