Trichotillomania

Alternative names
Compulsive hair pulling

Definition
Trichotillomania is hair loss caused by compulsive pulling and/or twisting of the hair until it breaks off. The hair may be lost in round patches or diffusely across the scalp. The effect is an uneven appearance. Other hairy areas may be plucked, such as the eyebrows, eyelashes, or body hair.

Causes, incidence, and risk factors

Trichotillomania is a type of compulsive behavior and its causes are not clearly understood. Symptoms usually begin before the age of 17. It may affect as much as 4% of the population. People with this disorder will often seek the help of a dermatologist initially. Women are 4 times more likely to be affected than men.

Symptoms

These symptoms are usually seen in children:

     
  • constant tugging, pulling, or twisting of hair  
  • increasing sense of tension is present before the hair pulling  
  • sense of relief, pleasure, or gratification is reported after the hair pulling  
  • hair pulling leads to an uneven appearance  
  • bare patches or diffuse loss of hair  
  • hair regrowth in the bare spots that feels like stubble  
  • some individuals may develop a bowel obstruction if they eat the hair they pull out  
  • other self-injury behaviors may be present  
  • people suffering from this disorder often deny pulling out their hair

Signs and tests
A biopsy may be done to rule out other causes, such as a scalp infection, to explain the hair loss.

Treatment

No expert consensus exists, however various medications, particularly antidepressants like fluoxetine (Prozac) have been shown effective in reducing symptoms.

Expectations (prognosis)
Typically, trichotillomania is limited to younger children who tend to outgrow the behavior. For most, the hair pulling is time-limited to 12 months. Early onset (before age 6) is associated with a better prognosis.

Complications
Complications usually arise when the pulled-out hair is eaten (trichophagia). This can result in intestinal obstruction or lead to malnutrition.

Prevention
Early detection remains the best form of prevention since it leads to early treatment. Decreasing stress in the environment might be beneficial, as stress may increase compulsive behavior.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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