Trichotillomania: The Hair-Pulling Disorder That’s More Common Than You Think

Sara Sampaio

Do you ever find yourself plucking hairs from your head, eyebrows, or eyelashes? Do you do it repeatedly to the point that you have patchy bald spots or noticeable hair loss? You may have trichotillomania, a mental health disorder that involves compulsively yanking out hair despite efforts to stop doing so.

Hair-pulling disorder occurs in about 1%-2% of American adults and more frequently in females, including Victoria’s Secret model Sara Sampaio. She recently spoke about having trichotillomania with Dr. Daniel Amen in an episode of Scan My Brain. “I pull on my eyebrows,” says the 31-year-old model. “It started when I was, I think 15.”

SYMPTOMS OF TRICHOTILLOMANIA

There are many signs and symptoms of trichotillomania, including:

  • Frequently pulling hair from body areas, such as the scalp, eyebrows, or eyelashes
  • Feelings of anxiety or tension prior to plucking out hair
  • A sense of anxiousness, tension, or discomfort when trying to refrain from pulling hair
  • Feelings of relief after pulling out hair
  • Thinning or sparse hair, noticeable hair loss, or patches of baldness
  • Eating, chewing, or biting hair that has been pulled out
  • Rituals related to hair pulling, such as searching out specific types of hair to pull or playing with hair after it’s been pulled out
  • Making repeated efforts to stop the behavior but feeling compelled to do it anyway
  • Feeling discomfort or distress about having others notice the habit or the signs of hair loss
  • Interferes with social functioning and at work, school, or home life

For some people, hair pulling is automatic, and they don’t even realize they are doing it. For others, it is a very focused activity that helps release tension. Individuals with this condition may also engage in other compulsive behaviors, such as biting their nails, skin picking, or chewing their lips. Sampaio says, “I tend to pick my lips a lot as well, and now I feel the need to do certain body movements.” She adds that “I just have so much tension everywhere that I feel like it just releases it.”

TRICHOTILLOMANIA AND OCD

Trichotillomania is considered to be a form of obsessive-compulsive disorder (OCD) and is believed to be related to anxiety. OCD is characterized by intrusive thoughts (obsessions) that cause distress and repeated behaviors (compulsions) that provide relief from that distress.

Obsessions are recurrent thoughts that trigger unpleasant feelings of anxiety, fear, or disgust. Common thoughts include fears about germs or contamination, harm or violence, forbidden sexuality, or religion. Some weird signs of OCD include worrying about the way you breathe or being afraid you’ll steal something. Some people can’t stop thinking about dying. There is a subtype of OCD called death anxiety OCD when a person is obsessed with thoughts about their own death or the death of a loved one. Sampaio says the death of her grandfather triggered a fear of dying. “All of a sudden, I just had this big, overwhelming fear of dying,” she says.

People with OCD engage in repetitive behaviors (compulsions) to calm feelings of distress. Common compulsions include excessive hand washing, extreme cleaning, counting, repeated touching, and more. In many cases, the compulsions must be performed in a ritualistic manner.

When left untreated, unwanted thoughts and compulsive actions can interfere with daily life and cause problems in relationships, careers, and in academic endeavors. When people eat their hair, it can form a large, matted hairball—called a trichobezoar—in the digestive tract. This can cause vomiting, weight loss, intestinal blockage, and in extreme cases, death.

 TRICHOTILLOMANIA, OCD, AND THE BRAIN

In people with trichotillomania, brain imaging studies have shown abnormalities in activity in certain regions of the brain, including areas involved in regulating impulses and habits, emotional processing, and reward processing. Neuroimaging research also points to abnormal activity in those with OCD.

At Amen Clinics, brain SPECT imaging scans of individuals with OCD show abnormal blood flow in some brain regions. SPECT (single photon emission computed tomography) is a nuclear medicine study that evaluates blood flow and activity in the brain. Basically, it shows three things: areas of the brain with healthy activity, too little activity, or too much activity. SPECT scans of those with OCD show increased activity in the following two regions:

  • Anterior cingulate gyrus (ACG): This brain region acts like a gear shifter, helping people go from one thought to another or from one action to another. Too much activity in the ACG is associated with getting “stuck” on recurrent thoughts or behaviors.
  • Basal ganglia: This area of the brain is involved in setting the body’s anxiety level and in the formation of habits. Overactivity in this region is associated with increased anxiety and fear.

The brain imaging work at Amen Clinics shows what many doctors miss about OCD—the fact that there is more than a single brain pattern associated with it.

TREATING TRICHOTILLOMANIA AND OCD

Treating trichotillomania and OCD requires a multi-modal approach that may include the following:

  • Cognitive behavioral therapy: A form of psychotherapy, CBT can be beneficial in changing unwanted habits and behaviors.
  • Stress-management techniques: Learning healthier ways to manage stress can be helpful in calming distressing thoughts and fears.
  • Getting “unstuck:” Implementing strategies to “get unstuck” and improve cognitive flexibility can help you shift away from unwanted thoughts.
  • Physical exercise: Multiple studies have demonstrated that physical activity can boost cognitive flexibility and enhance moods.
  • Nutraceuticals: Among the nutritional supplements that help calm an overactive brain are saffron, 5-HTP, l-tryptophan, St. John’s Wort, and magnesium.
  • Medications: In some cases, medications such as antidepressants may be an effective part of a comprehensive treatment program.

With treatment that is targeted to your brain and individual needs, it is possible to stop struggling with disorders such as hair pulling and other OCD-related obsessions and compulsive behaviors.

Trichotillomania, OCD, and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.

7 Comments »

  1. I'm a barber/hairstylist. I've had many clients with this disorder including children.

    Comment by Carol Wolff — October 14, 2022 @ 9:33 AM

  2. I'm milian and i'm also experiencing same issues , can't seem to stop pulling out my hair i need help please.

    Comment by Milian — October 24, 2022 @ 8:31 PM

  3. I am nearly 70 and have had tri h since I was 12 I seem to have just been able to control my urges in the last couple of years….it is growing but quite thin…but it’s there👍

    Comment by Glenda Matthews — January 19, 2023 @ 6:48 AM

  4. I am almost 72 and started pulling my hair at around age 11-12. There was trouble in my home that I now know it had to come from. I just recently in the last few years found out what was wrong with me. It has been so very difficult over all these years bc of being so embarrassed about it and at the same time not being able to stop. When I was about 14 I had to start wearing a hair piece and I’ve never been able to tell ppl what’s wrong. I had to start wearing a wig at around 48 and have worn them all these years. My impulses have come and gone over time but used to be bad and often. When I’d go for several months of not pulling, I’d think I was ok and would never do it again, then boom! I’m am much better as I’ve gotten older but I wish so badly that I could find something to restore the damage that’s been done. Even at my age now, I’m still too embarrassed to tell my family my problem. My children, grands and great grands , even my recently passed husband of 52 years never saw me without my wig. I even dread when I pass, knowing what will happen and wondering if they will get my hair on right. 😢😢😢 God help those who have this awful condition!

    Comment by Trish — March 23, 2023 @ 4:57 PM

  5. I started pulling
    G my hair at 1 I I was pregnet with my daughter I remember exactly what I was watching on TV were I was who was with me and everything. I'm now 49 and wear wigs it has been apart of my self identity longer then it has not. I just shave and wear wigs since the damage at the top of my head is irreversible and the hair will never grow back.

    Comment by Brenda — May 11, 2023 @ 5:41 PM

  6. Kudos to those who left comments. Some helped explain why my hair isn’t growing. I’m gonna guess it’s also the reason I went from blonde to dark brown even though all my siblings are super blonde (all 9 of them, plus all my nieces and nephews, lol).

    I’ve tried suggested approaches, but I’m fairly certain I’ll always wear a hat. I don’t think i’m lazy, because I have tried multiple approaches (most all of the listed ones), but every few years the impulse returns and I must admit I feel like a im not trying hard enough to stop.

    Mom even bought me bracelets that track my movements and vibrate when they recognize the hair pulling motion (Keen).

    I really enjoyed reading the comments and not feeling so alone. Thanks you to all.

    Comment by Cas — May 19, 2023 @ 4:58 PM

  7. I have this. It started around the 6th grade. In the summer. I started to become obsessed with the root. I wanted to get rid of it and I could not stop. I have an extremely chaotic life growing up and won’t be shocked if it was due to someone sexually abusing me back then. I started smoking in the 7th grade and also drank but o my on weekends. I quit both in my late twenties after I married and had my family. I have very curly beautiful hair after being almost naked by age 13. I’m very very lucky because it all grew back in. I still have small area on my head I cover up well. I started pulling out my public hair on a daily basis now. I am also on a snide press any for panic attacks that helps me be able to drive. I’m 58 now, had cancer and more. Overcame it all. Life is so short. Just be happy.

    Comment by Kimberly — September 18, 2023 @ 11:36 AM

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