What is Trichotillomania? Aneela's Story

Did you just Google "Why am I pulling out my hair?" and land up here?

If so, WELCOME! to the way basically everyone with trichotillomania figures out they have trich.

How do I know? Because I have dealt with Trichotillomania for more than TWO DECADES! Hi! My name is Aneela & yep, I pull out my hair. I'm not ashamed of it. And if you pull, you aren't ashamed of it either. 

Now while Mayo Clinic & Wikipedia will tell you "what is trichotillomania?" I'll tell you too & I'll one up 'em - I'll tell you how you can take control of it.

But first, let's learn about this medical, mental health condition that 1 in 25 people suffers from to a debilitating degree, shall we?

This information below is made available courtesy of the Trichotillomania Learning Center Foundation for Body Focused Repetitive Behaviors. Be sure to visit their website at http://www.bfrb.org/

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What is Trichotillomania?

Trichotillomania (trick-o-till-o-may-nee-uh) (TTM or "trich"), also known as Hair Pulling Disorder, is characterized by the repetitive pulling out of one's hair. Trichotillomania is one of a group of behaviors known as Body-Focused Repetitive Behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their hair, skin, or nails, resulting in damage to the body - and  mind.

Research indicates that about 1 or 2 in 50 people experience trichotillomania in their lifetime. It usually begins in late childhood/early puberty. In childhood, it occurs about equally in boys and girls. By adulthood, 80-90% of reported cases are women. Hair pulling varies greatly in its severity, location on the body, and response to treatment. Without treatment, trichotillomania tends to be a chronic condition; that may come and go throughout a lifetime.

Trichotillomania Symptoms

Trichotillomania is currently classified as an "Obsessive Compulsive and Related Disorder" in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

The DSM-5 diagnostic criteria include:

  • Recurrent hair pulling, resulting in hair loss
  • Repeated attempts to decrease or stop the behavior
  • Clinically significant distress or impairment in social, occupational, or other area of functioning
  • Not due to substance abuse or a medical condition (e.g., dermatological condition)
  • Not better accounted for by another psychiatric disorder

Hair pulling may occur across a variety of settings and both sedentary and active activities. There are times when pulling occurs in a goal-directed manner and also in an automatic manner in which the individual is less aware. Many individuals report noticeable sensations before, during, and after pulling.  A wide range of emotions, spanning from boredom to anxiety, frustration, and depression can affect hair pulling, as can thoughts, beliefs, and values.

Although the severity of hair pulling varies widely, many people with trichotillomania have noticeable hair loss, which they attempt to camouflage. Thinning or bald spots on the head may be covered with hairstyles, scarves, wigs, or makeup. Those with missing eyelashes, eyebrows, or body hair, may attempt to camouflage with makeup, clothing, or other means of concealing affected areas.

Due to shame and embarrassment, individuals not only try to cover up the effects of trichotillomania, but may avoid activities and social situations which may lead them to feel vulnerable to being "discovered" (such as windy weather, going to the beach, swimming, doctor's visits, hair salon appointments, childhood sleepovers, readying for bed in a lighted area, and intimacy).

Treatments for Trichotillomania

Download Expert Consensus Treatment Guidelines

The most important thing that a person can do to address a BFRB is to first  become knowledgeable about the problem and its treatment. The TLC Foundation for Body-Focused Repetitive Behaviors (www.bfrb.org) provides up-to-date information regarding BFRBs, with guidance from its Scientific Advisory Board, comprised of expert clinicians and researchers working in this field. Books, lectures, videos, webinars, professional training and articles are all available through the foundation, as well as educational events that are held regularly around the country for interested therapists and for individuals and families whose lives have been affected by BFRBs. Some of the most common treatments take the form of behavioral therapy and medication.

Behavioral Therapy

Below are some of the top treatments for trichotillomania among other body-focused repetitive behaviors. Please refer to the treatment guidelines pdf provided in the above link for more detailed information on each of these:

Cognitive Behavior Therapy (CBT)

CBT is a therapeutic approach that focuses on identifying thoughts, feelings and behaviors that are problematic and teaches individuals how to change these elements to lead to reduced stress and more productive functioning.

Habit Reversal Training (HRT)

HRT is the method that has been examined most in research studies. HRT has a varying number of components in its treatment package. The three components that are considered most critical are awareness training, competing response training and social support.

Comprehensive Behavioral (ComB) Treatment

The ComB model is based on the assumption that a person engages in their BFRB because it meets one or more need in the individual (e.g., helping to relax, to fall asleep, or to feel like a goal was accomplished).

Acceptance and Commitment Therapy (ACT)

A promising treatment approach that may serve to add strength to other cognitive behavior therapies is called acceptance and commitment therapy (ACT). This approach differs from others in that it promotes an increased acceptance of, and tolerance for, urges to pick or pull, without acting to reduce or eliminate them.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is another treatment approach that may add to the effectiveness of other learning-based therapies. DBT has four modules including mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.


While the main treatment for trichotillomania and skin picking is behavior therapy, medications often can be helpful. No one medication helps everyone with skin picking or hair pulling, though a few have been found to reduce symptoms in
some individuals.

Medications are often used to lessen feelings or sensations that can increase picking or pulling rather than treat the disorder itself. Some research has suggested that taking medications temporarily allows individuals to make better use of behavioral techniques that would otherwise not have been as helpful. Some medications work only if taken every day, while others may help if taken as needed for certain times of the day or stressful situations.

See the expert consensus treatment guidelines for more information.

Treatment is a Process

Behavior change is a process that involves both forward and backward movement over time. Even with successful treatment of BFRBs, slips are often a normal part of the landscape and should be expected. It is important to understand that treatment is typically not a miracle cure that results in complete remission of the problem, but that improvements are more likely to be slow and steady. When slips in behavior occur, it is important to ascertain why they happened and refocus on getting back on track. Being negative or giving up is not helpful and can lead a person to a complete relapse. When slips are handled well, learning can take place and improvement in behavior can follow.

To minimize slips and setbacks, it is essential to remain vigilant. Once a BFRB like trichotillomania has developed, it is important to be aware that it is possible to reoccur, even after a significant period of remission. In the event of the return of the BFRB itself, or of strong urges, techniques and strategies that worked best during active treatment can be re-employed during vulnerable phases. Some individuals find it especially useful to check in with their therapist for added support. In some situations, the formerly useful techniques may no longer be as effective as they once were. This would present a good opportunity to see a therapist and explore some additional interventions or approaches.

See the expert consensus treatment guidelines and the resources below for more information.