Why do some people pull out their hair? Trichotillomania explained.

Trichotillomania — also known as hair-pulling disorder — is an impulse control disorder that “involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop,” according to the Mayo Clinic.

Racine R. Henry, a family therapist who treats patients with anxiety and depression, tells Yahoo Life that “trichotillomania is essentially a physical coping method and can manifest from a variety of circumstances. For some it is the ‘compulsion’ of their obsessive-compulsive disorder. For others it is a subconscious response to feelings of fear, stress and/or anxiety.”

Still others pull out hair because they are bored, frustrated or impatient, according to research published in the Journal of Behavior Therapy and Experimental Psychiatry.

Clinical psychologist Amy Marschall tells Yahoo Life that, as with many diagnoses, there isn’t one single cause of trichotillomania. “Symptoms can start following a traumatic or stressful event,” she explains. “Hair pulling can also be a stim [self-stimulatory] behavior for autistic people, an anxiety response or an obsessive-compulsive behavior.”

Marschall points out that although it’s a self-soothing behavior, people with trichotillomania are not choosing to pull their hair out — the behavior is a symptom of mental health issues.

Who is at risk for developing trichotillomania?

The condition affects about 5 million to 10 million Americans and is much more common in girls and women. According to the Mayo Clinic, trichotillomania typically starts in adolescence — between ages 10 and 13.

People who are predisposed to anxiety or depression are more likely to develop the disorder. Also, those who have not developed effective coping methods can turn to hair pulling as a way to deal with stressful situations.

If someone has other body-focused repetitive behaviors, such as skin picking, they may be more likely to develop trichotillomania than those who do not have those other behaviors. It can also be more common in trauma survivors than other populations. Additionally, genetics may also play a role in whether a person develops the condition.

How hair pulling affects people’s lives

There are emotional and social consequences as well, notes Henry, including isolation, depression, gaining or losing weight in response to the stress, and loss of relationships. “I’ve also seen cases where other, more severe compulsions developed once hair was no longer available.” says Henry. “What begins as trichotillomania can become cutting, substance abuse ... and/or eating-related disorders.”

There are emotional and social consequences as well, notes Henry, including isolation, depression, gaining or losing weight in response to the stress, and loss of relationships. “I’ve also seen cases where other, more severe compulsions developed once hair was no longer available.” says Henry. “What begins as trichotillomania can become cutting, substance abuse... and/or eating-related disorders.”

Although people with trichotillomania often feel relief, satisfaction or other positive emotions when they pull out hair, the behavior also comes with feelings of shame and embarrassment, particularly when hair loss is physically apparent. “For Black women who already face social pressures to have their hair in a particular condition at all times, the emotional repercussions of hair pulling are intensified,” says Henry. “In men with this diagnosis, shame can be found in irreversible hair loss that can be related to premature signs of aging.”

What are the treatment options for trichotillomania?

Treating trichotillomania involves the use of therapy, medications — including antidepressants — or a combination of both.

Body-focused repetitive behaviors like trichotillomania are often done without the person even realizing it. So Marschall advises helping the person notice when they are engaging in the behavior in a gentle and nonshaming way so they can try to stop in the moment. She also points out that “behaviors meet needs,” so it helps to work with a mental health professional to “determine the underlying need — stress relief, sensory regulation, etc. — and help the person meet it in a healthy and nonharmful way, and the behavior can stop.”

Henry says that when it comes to treating the disorder, “the simple answer is to replace the benefits of trichotillomania with an equally effective but more positive behavior.” The complicated answer, however, is that “hair pulling often provides physical, mental and emotional relief that a person relies on and needs. The hardest part of change is often in taking the risk to abandon what is comfortable, despite being traumatic or negative, for the uncertainty of the unknown.”

If you or someone you know has symptoms of trichotillomania, can’t stop the behavior and feel embarrassed about it, experts recommend seeking help from a health care professional or therapist.

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