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Trichotillomania - top of the head
Trichotillomania - top of the head

Trichotillomania
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 a moth-eaten appearance. Other hairy areas may be plucked, such as the eyebrows, eyelashes, or body hair.

Alternative Names:
Compulsive hair pulling

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 moth-eaten appearance
  • bare patches to 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-mutilation 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 since stress may increase compulsive behavior.
Review Date: 1/29/2002
Reviewed By: Benoit Dubé, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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