The symptoms are generally reported by friends or family members of the person directly plucking of one’s hair, resulting in significant hair loss. Patients usually pluck one hair at a time and the urge is continuous lasting for hours together.

There are phases of remission in between two episodes. This phase of remission can continue for many days or months or even few years. Patients seek solitude while doing this activity. They are affected psychologically and suffer from fear of appearing socially [5] [8]. They manipulate their appearance in order to look appealing. This is done by wearing hair extensions or hats, scarves etc.

Hair pulling is highly prevalent in association with stress and anxiety. The individual feels mentally relieved and his anxiety reduces by pulling his hair. Some people also ingest the plucked hair. This leads to formation of trichobezoar, a hair ball formation in the gut. An extreme form of trichobezoar leads to the hair ball tail extending to the intestine [7]. This condition is called Rapunzel disease. This condition is fatal if not diagnosed. Other factors such as a sedentary lifestyle, lying in bed, idealism can contribute to such activity. Children are especially prone to develop this habit.

• Fatigue

  Hair possesses many sensory qualities that lure people into a semi-trance, switching one's focus from an emotional state (ie anxiety, fatigue, boredom) to a more hypnotic state. [behaviortherapynyc.com]

  Cancer Borderline Personality Disorder Brain Cancer Brain Injury Breast Cancer Breastfeeding Bulimia Bullying Burn COPD Caffeine Career Changes Caregivers Carpal Tunnel Syndrome Celiac Disease Cerebral Palsy Cervical Cancer Chantix Chemotherapy Chronic Fatigue [trichotillomania.supportgroups.com]

  For people with trichotillomania, the sensation of plucking each hair out is not painful, but brings a deep sense of satisfaction and relief that can temporarily sooth negative emotions such as stress, anxiety, loneliness, fatigue or frustration. [sane.org]

  For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration. Positive feelings. [mayoclinic.org]

• Malnutrition

  Anemia, malnutrition, and digestive disorders, including bowel obstructions, can develop, if trichotillomania develops into trichotillophagia or eating of the hairs. Trichobezoars, or hairballs, can form when the hair is bitten off and ingested. [encyclopedia.com]

• Nightmare

  CNS effects (including nightmares, insomnia, dizziness, irritability, anxiety and a feeling of doom) as a category affected 22 of 23 participants (95.7%) during the fluoxetine phase of the trial versus 16 of 23 participants (69.6%) during the placebo [doi.org]

• Asymptomatic

  […] putative obsessive–compulsive-spectrum disorders in terms of neurobiology. 6, 40 The functional significance of these grey matter abnormalities requires clarification in follow-up longitudinal studies, and in studies of unaffected first-degree relatives (asymptomatic [web.archive.org]

• Cough

  Vocal tics may include throat clearing, coughing, and sniffing. Trichotillomania is a body-focused repetitive behavior in which a person pulls out his or her hair, usually from the scalp, eyelashes, or eyebrows. [nyulangone.org]

  Further, trichotillomania could be a symptom caused by different factors in different individuals just as a cough can be produced by a multitude of different medical problems. Finding the cause(s) will take more research. [mentalhealthamerica.net]

  Of participants receiving placebo (N = 25), one complained of nausea, two of diarrhoea and one of cough. No participants withdrew from the study as the result of adverse effects. [doi.org]

• Constipation

  Trichobezoars can also cause foul breath, poor appetite, constipation, diarrhea, excessive gas, bowel obstruction, and even bowel perforation. Liver and pancreas functions can be adversely altered. [diagnose-me.com]

  It may present with abdominal pain, nausea, vomiting and constipation. It may also cause bowel obstruction or perforation. [dermnetnz.org]

  Trichobezoars can also cause foul breath, poor appetite, constipation, diarrhoea excessive gas, bowel obstruction, and even bowel perforation. Liver and pancreas functions can be adversely altered. [ocdireland.org]

  Common adverse effects in participants taking clomipramine were tremor (three of 10; 30%), sedation (two of 10; 20%), dry mouth (two of 10; 20%) and constipation (two of 10; 20%). [doi.org]

  Trichophagia may cause constipation, weight loss, intestinal obstruction, intussusception, erosion of the gastric wall, obstructive jaundice, protein-losing enteropathy, and anemia. Figure 6. A trichobeazor at the time of removal. [clinicaladvisor.com]

• Heart Disease

  Disease Cuts Both Ways AHA News: Woman's Frozen Face, Garbled Speech During Zoom Call Were Signs of a Stroke View All News > View All News > ABOUT Overview History Editors and the Editorial Process Publishing and Production Staff Editorial Board Contributors [msdmanuals.com]

  Grief HIV HOCD HPV Hair Loss Healthy Eating Healthy Sex Heart Attack Heart Disease Heartburn Hepatitis C Heroin Herpes High Blood Pressure High Cholesterol Hives Hoarding Hodgkins Lymphoma Huntingtons Disease Hyperthyroidism Hypothyroidism Hysterectomy [trichotillomania.supportgroups.com]

• Osteoporosis

  Vitamin D deficiency is thought to be linked to rickets in children and to a range of different diseases in adults, including osteoporosis, osteomalacia, cardiovascular diseases, cancer, dermatological diseases, and psychiatric disorders. [ncbi.nlm.nih.gov]

  Lymphedema Lyrica Marijuana Medicaid Medicare Menopause Metformin Meth Methadone Migraine Military Military Family Miscarriage Moms Morphine Multiple Sclerosis Naproxen Narcissist Narcolepsy Neurontin Non Hodgkins Lymphoma Nutrition OCD Obesity Online Dating Osteoporosis [trichotillomania.supportgroups.com]

• Alopecia

  Nobody in the family history suffered from alopecia areata, but her father has male androgenetic alopecia (Norwood/Hamilton MAGA C3F3). [ncbi.nlm.nih.gov]

  Trichotillomania must be differentiated clinically from other alopecias (eg, alopecia areata, traction alopecia, androgenetic alopecia, pseudopelade, alopecia mucinosa ) by careful physical examination and patient history. [emedicine.medscape.com]

• Skin Disease

  When individuals lose their hair or eyebrows, doctors may first check for other conditions that might cause a person's hair to fall out, like ringworm, * alopecia areata, * or other skin diseases. [humanillnesses.com]

  Treatment of Skin Disease. Mosby: London, 2002:P637-639. 5. Cotterill JA, Millard LG. Psychocutaneous disorders. In: Champion RH, Burton JL, Burns DA, Breathnach SM, editors. Rook/Wilkinson/ Ebling. Textbook of Dermatology 6" edn. [ijdvl.com]

• Compulsive Disorder

  It is related to compulsive disorders as changes are observed in certain neurotransmitters like serotonin, leading to obsessive compulsive disorder. This is an inherited disorder and often runs in families. [symptoma.com]

  Trichotillomania is a form of obsessive-compulsive disorder (OCD) sometimes referred to as hair-pulling disorder. An obsession is some sort of intrusive thought, and trichotillomania’s obsession is thoughts of hair pulling. [healthprep.com]

  Trichotillomania is often accompanied by other symptoms, such as anxiety, depression, obsessive compulsive disorder or Tourette's syndrome. People with the disorder may have hair loss or bald patches, but often mask their habit. [news.bbc.co.uk]

  Although Trichotillomania is listed under ‘Obsessive-Compulsive Disorder and Related Disorders’ in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM), similarly to skin picking, it is not exactly the same as Obsessive-Compulsive Disorder [ocduk.org]

• Compulsive Behavior

  Interestingly, these feelings aren’t traditionally thought of as triggering compulsive behaviors. [yahoo.com]

  Pharmacologic modulation of the glutamate system may prove to be useful in the control of a range of compulsive behaviors. clinicaltrials.gov Identifier: NCT00354770. [ncbi.nlm.nih.gov]

  Source Trichotillomania, also known as compulsive hair pulling disorder, is a very real condition that affects up to 3.4 percent of the world population ( source. )Similar to other compulsive behaviors such as gambling and food addiction, those affected [pavlok.com]

  With time and practice, the brain can begin to react differently to the urges, and the person can start to control the compulsive behavior. [humanillnesses.com]

  Decreasing stress can help, because stress may increase compulsive behavior. References Morelli JG. Disorders of the hair. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. [web.archive.org]

• Behavior Disorder

  Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one's hair, resulting in secondary alopecia. [ncbi.nlm.nih.gov]

  Access provided by Trichotillomania (TTM) is a chronic behavioral disorder characterized by the irresistible urge to pull out one's hair, resulting in noticeable hair loss. 1 Clinically, TTM is classified as an impulse-control disorder and believed to [doi.org]

• Addictive Behavior

  Hair pulling more closely resembles compulsive or addictive behavior. People with trichotillomania are not always aware they are pulling out their hair. [goodtherapy.org]

  addictive behavior (e.g., ). [doi.org]

  Like all forms of self-harm, trichotillomania can become an addictive behavior. With time, it becomes harder and harder to stop; that is why it's best to bring it under control as soon as possible. [wikihow.com]

  addictive behavior (e.g., [ 49 ]). [ncbi.nlm.nih.gov]

• Chronic Anxiety

  Rufer M, Moergeli H, Moritz S, Drabe N, Weidt S: Alexithymia and non-treatment: an Internet based study of 312 people with chronic anxiety. Compr Psychiatry 2014;55:179-187. [karger.com]

• Stroke

  Some people eat part or all of the hair, stroke, count, store or fiddle with the hair after pulling. [web.archive.org]

  Rare: CDC AHA News: El vínculo entre la depresión y las enfermedades del corazón tiene un doble sentido AHA News: Link Between Depression and Heart Disease Cuts Both Ways AHA News: Woman's Frozen Face, Garbled Speech During Zoom Call Were Signs of a Stroke [msdmanuals.com]

  Do you touch or stroke your hair? Touch your face, eye lashes? Response detection procedure. Describe and experience the muscles you use when pulling, using the following exercise: Extend arm straight and hold for 10 seconds. [ocdhope.com]

  Info Sex Addiction Sexual Abuse Sexual Harassment Shingles Shopping Addiction Shyness Siblings Single Dads Single Moms Single Parents Singles Skin Cancer Skin Picking Sleep Apnea Sleep Walking Smoking Social Anxiety Social Security Spina Bifida Stress Stroke [trichotillomania.supportgroups.com]

  I would stroke the tip of my thumb along my lashes, searching for the one that felt different so that I could target it like my bully targeted me. By my 11th birthday, my eyelids were red and bare. [psmag.com]

• Agitation

  […] the case of an adult woman with a personal history of childhood maltreatment and psychiatric morbidity (major depression, trichotillomania, and conversion disorder), who was referred to the sleep unit because of nocturnal hair-pulling and psychomotor agitation [ncbi.nlm.nih.gov]

Microscopic examination of the collected plucked hair helps in the diagnosis of this condition. The pattern of hair suggests the anagen or telogen count. Anagen hair are typical of trichotillomania. Multiple longitudinal and transverse sections are obtained [7] [9]. The hair showing an exclamation mark are typical of alopecia areata. Biopsy from the scalp is the most reliable in achieving the diagnosis.

Before initiating any treatment, evaluation of the case is necessary. First determine whether the symptoms represent more of a habit than a real disorder. Secondly, one must evaluate whether the patient requires further investigations such as MRI or a CT scan to rule out further pathology such as trichobezoars syndrome. Thirdly, its necessary to evaluate the level to which the patient is affected psychologically [7] [10]. This is achieved with the help of a psychiatrist or a clinical psychologist.

The treatment is mainly with behavioral correction. This includes ways to reduce and deal with stress. Observing and evaluating one’s own behavior before and after the episodes. Training the patient by teaching them forms of alternative behavior during the time he feels the urge to start pulling hair. This alternative activity should be socially sound. They are encouraged to practice it regularly and frequently. Certain relaxation techniques are advised to help in relaxing the mind.

In general, for reversing this habit, the role of parents is very important. Initial aid needs parent’s attention and care [11]. They should support them socially and personally and communicate with them frequently.

Medications include antidepressants to reduce mental disturbance. These are mainly tricyclic antidepressants that act to interfere with the serotonin uptake by the neurons. Fluoxetine and sertraline are commonly used and they are found to be safe for children aged 8 to 17 years [7] [11].

Younger children show excellent prognosis as in them this disorder is more like a habit. As age increases the prognosis is usually fair. In older age group, the prognosis deteriorates and cure is rare. This illness causes more morbidity than mortality.

There is social and occupational distress especially in the adult age group. The illness usually lasts from weeks to many years; hence, a planned treatment under an excellent psychiatrist is very important. Eating of the pulled out hair leads to conditions such as anemia, gastric complaints, intestinal obstruction and also icterus [6] [7]. It must be immediately attended to.

Theories suggest that an individual releases his or her stress and anxiety by pulling his hair. It like a coping mechanism for stress and is often to be present together with thumbsucking in younger patients [2]. It is related to compulsive disorders as changes are observed in certain neurotransmitters like serotonin, leading to obsessive compulsive disorder [3].

This is an inherited disorder and often runs in families. There are changes in a particular gene leading to trichotillomania. In some individuals, this disorder helps in easing out one’s emotional distress; hence, in a way they harm themselves to seek relief from anxiety and mental stress. Certain degenerative neurological disorders such as Parkinson’s and dementia are also associated with trichotillomania.

Many individuals deny of suffering from this disorder. In the US, about 8 million people are estimated to be suffering from this illness. Trichotillomania is prevalent in all age groups, most commonly between 12-13 years. Females are more common and female to male ratio is 3 by 1 [4] [5].

Hair pulling areas differ with age. Those who are young are found to pull more of eyelashes and eyebrows and those with a significantly older age pull more of pubic hair [5].

As trichotillomania is a psychiatric disorder, its neurobiological studies are inadequately conclusive. Certain studies reveal that changes in the basal ganglia lead to this habit forming disorder. After studying the MRI scans of about 18 patients of trichotillomania and other 18 normal healthy subjects, it was concluded that decrease in the cerebellar volume and increase in the amount of the gray matter were important findings noted with individuals suffering from trichotillomania. [7]

Many individuals do not accept or want to be aware of the problem of hair plucking they suffer from until it’s too late. Hence, in order to stop its further progress firstly the person should be committed; he should accept his illness and increase his willingness to overcome the disorder. This can be achieved by noticing triggers, urges, feelings when he gets the desire.

The next step is to use obstacles such as wearing gloves, or clipping the hair together, shaving that part of hair to a very short size or even putting straps on fingers. This interrupts the activity and helps the person to become conscious before he attempts such an unwanted activity [12]. This repulsion of desire could lasts for few minutes or hours.

Aim should be made to increase the amount of plucking-free time. Patients should be encouraged and rewarded for every effort put by them in this process. Their emotions anxiety should be inquired and an appropriate counseling treatment should be initiated.

Trichotillomania is also called as trichotillosis. It’s an obsessive compulsive disorder where a person has a compulsive desire to pull out his hair resulting in mild to significant hair loss [1].

Most often, the person pulls scalp hair, but it can be from any other body part also such as eyebrows, eyelashes, beard or pubic area. This can result in baldness of that area. It has been categorized as a mental and behavioral abnormality. Any dermatologic link does not exist [1].

Trichotillomania is a psychological disorder in which the person gets a compulsive desire to pluck out his or her own hair. This desire is mainly from the scalp, but it can also include eyelashes, eyebrows, beard or hair from genital region. It affects all individuals. In kids it represents mostly a habit disorder but as it becomes more chronic it can transform into a serious illness. Teenage children are common victims of this disorder.

The cause is mainly mental disturbance, anxiety, depression, emotional trauma etc. they also suffer from social withdrawal due to embarrassment.

Treatment includes exclusive psychological counseling from an expert psychiatrist. Besides this, parents play a very important role. They need to understand their child’s problem and help him out. Motivation, encouragement and love help a child in overcoming his or her difficulties. They should teach their kids an alternative activity whenever the child gets the desire to perform the undesired hair pulling activity. This alternative method should be socially appropriate. The child should record his behavior and timing when he gets the urge. Certain mental easing out techniques helps the child in overcoming his anxieties and fears. Physically certain obstacles such as clipping the hair together or cutting the hair very short helps in reducing the urge.

1. Chamberlain SR, Odlaug BL, Boulougouris V, Fineberg NA, Grant JE. Trichotillomania: neurobiology and treatment. Neurosci Biobehav Rev. 2009 Jun;33(6):831-42.
2. Watson TS, Allen KD. Elimination of thumb-sucking as a treatment for severe trichotillomania. J Am Acad Child Adolesc Psychiatry. Jul 1993;32(4):830-4
3. Harrison JP, Franklin ME. Pediatric trichotillomania. Curr Psychiatry Rep. 2012 Jun;14(3):188-96..
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10. Leombruni P, Gastaldi F. Oxcarbazepine for the treatment of trichotillomania. Clin Neuropharmacol. 2010 Mar-Apr;33(2):107-8.
11. Virit O, Selek S, Savas HA, Kokaçya H. Improvement of restless legs syndrome and trichotillomania with aripiprazole. J Clin Pharm Ther. 2009 Dec;34(6):723-5.
12. Peabody T, Reitz S, Smith J, Teti B. Clinical management of trichotillomania with bimatoprost. Optom Vis Sci. 2013 Jun;90(6):e167-71.