Trichotillomania In Teens: Definition, Symptoms, Causes, and Treatment

Trichotillomania, or hair-pulling disorder, is a mental health condition characterized by an irresistible urge to pull out one’s hair, leading to noticeable hair loss.

Symptoms of trichotillomania include physical (hair loss, skin damage, trichophagia) psychological (anxiety, depression, poor self-esteem), and behavioral-social (ritualistic hair pulling, social isolation, and compulsive behavior).

Causes of trichotillomania in teens are biological (genetic predisposition, neurotransmitter imbalances, abnormalities in the brain), psychological (stress, anxiety, obsessive-compulsive traits, emotional regulation problems), and social factors (family dynamics, peer pressure, social influence).

Trichotillomania is diagnosed through a combination of a physical examination (hair loss, visible signs of hair pulling and psychiatric evaluation (hair pulling behavior, emotional and functional impact)

Treatment approaches for Trichotillomania In teens include psychotherapy (habit reversal training), mindfulness-based stress reduction, and support groups.

Medications used to treat Trichotillomania are selective serotonin reuptake inhibitors and naltrexone and n-acetylcysteine (NAC).

Trichotillomania is not a type of self-harm, but rather a body-focused repetitive behavior (BFRB).

Trichotillomania is not contagious. The disorder is not infectious and does not spread to others.

What Is Trichotillomania In Teens?

Trichotillomania (TTM), also called hair-pulling disorder or compulsive hair-pulling, is a mental health condition that causes teens to experience an uncontrollable, irresistible urge to pull out their hair. According to the 2024 article “Trichotillomania”, from the Genetic and Rare Diseases Information Center (GARD), this mental disorder is classified under the obsessive-compulsive category. Teens with trichotillomania often pull their hair out in response to stress, anxiety, or boredom. They normally pull out a few hairs at a time or one strand at a time. Some look at, play with, chew, or even eat the hair after pulling it out. 

People with trichotillomania usually experience temporary pleasure or relief from pulling their hair out, but also feel shame or embarrassment about their condition due to noticeable hair loss. The condition typically begins in late childhood or early adolescence and is more common in females than males​.

According to a 2022 article by Berger F K.,” Trichotillomania”, from Medline Plus the disorder begins in late childhood or early adolescence. It affects 4 percent of the population with women susceptible 4 times, compared to men.

What Is The Difference Between Trichotillomania And Obsessive-Compulsive Disorder (OCD)?

1. Obsessions vs Compulsions: OCD is primarily driven by obsessions – intrusive thoughts, images, urges, or sensations that cause distress as demonstrated in the article “ Trichotillomania (Hair Pulling Disorder)”, from OCD-UK. Compulsions are performed to reduce this distress. Trichotillomania lacks significant obsessional thoughts. Hair pulling is not in response to obsessions, but rather an irresistible urge.

2. Pleasure vs Anxiety Relief: In OCD, compulsions do not provide pleasure, only temporary relief from anxiety. In trichotillomania, the act of hair pulling offers feelings of relief or positive emotions, even though the sufferer does not want to continue pulling.

What Is The Relation Between Trichotillomania And Skin-Picking Disorder?

1. Co-Occuring Disorders: The two disorders frequently co-occur, with many individuals experiencing both hair-pulling and skin-picking behaviors, as demonstrated in the 2015 study by Jon E., et al, “Trichotillomania and Skin-Picking Disorder: Different Kinds of OCD”, published from Psychiatry Online. They share similar symptoms, triggers, and psychological characteristics.
2. Body-Focused Repetitive Behaviors: Trichotillomania and skin-picking disorder are closely related disorders that are both classified as body-focused repetitive behaviors (BFRBs) under Obsessive-Compulsive and Related Disorders in the DSM-5.
3. Compulsive Behaviors: Both disorders involve repetitive, compulsive behaviors that lead to physical damage (hair loss, skin lesions) and significant distress or impairment in daily life.

What Are The Symptoms of Trichotillomania In Teens

Symptoms of trichotillomania include physical (hair loss, skin damage, trichophagia) psychological (anxiety, depression, poor self-esteem), and behavioral-social (ritualistic hair pulling, social isolation, and compulsive behavior). According to the 2022 article by Berger, symptoms of trichotillomania include hair loss, constant pulling of hair, and a sense of pleasure or relief after hair pulling. 

Physical Symptoms of Trichotillomania In Teens

1. Hair Loss: The most apparent physical symptom of trichotillomania is hair loss, which occurs in patches or more diffusely across the scalp. Teenagers also pull hair from other areas such as eyebrows, eyelashes, and body hair.
2. Skin Damage: Repeated pulling leads to skin damage, including redness, sores, and even infections if the skin breaks.
3. Trichophagia: Some teens might eat the hair they pull out (trichophagia), which results in serious complications such as gastrointestinal blockages.

Psychological Symptoms of Trichotillomania In Teens

1. Anxiety: Many teens with trichotillomania experience high levels of anxiety. The act of hair-pulling is often a response to stress or a way to relieve tension.
2. Depression: The chronic nature of the disorder and its visible consequences lead to feelings of sadness and hopelessness.
3. Poor Self-Esteem: The noticeable hair loss and the inability to control the urge severely impact a teen’s self-image and confidence, leading to social withdrawal.

Behavioral and Social Symptoms of Trichotillomania In Teens

1. Compulsive Behavior: The primary behavioral symptom is the compulsion to pull out hair. This behavior often occurs in private to avoid detection, though it also happens in public settings.
2. Ritualistic Pulling: Some teens develop specific rituals around hair pulling, such as only pulling certain types of hair or pulling in a particular manner.
3. Social Isolation: Due to embarrassment or fear of judgment, teens with trichotillomania withdraw from social activities and interactions. This isolation worsens the psychological distress.

What Are The Causes Of Trichotillomania In Teens

Causes of trichotillomania in teens are biological ( genetic predisposition, neurotransmitter imbalances, abnormalities in the brain), psychological (stress, anxiety, obsessive-compulsive traits, emotional regulation problems), and social factors (family dynamics, peer pressure, social influence). According to the 2024 article from GARD, trichotillomania is caused by genetic and environmental factors.

Biological Causes of Trichotillomania In Teens

1. Genetic Predisposition: Research indicates a genetic component to trichotillomania as demonstrated in the 2007 study by Feng G., “Gene Triggers Obsessive Compulsive Disorder-Like Syndrome in Mice,” from the National Institutes of Health (NIH). During the study, researchers bred mice without the SAPAP3 gene which caused problems in the brain circuit, resulting in obsessive-compulsive disorder (OCD) traits. The mice exhibited anxiety, and compulsive grooming which resulted in bald patches on their heads.
2. Neurochemical Imbalances: Neurotransmitter imbalances, particularly involving serotonin and dopamine, play a crucial role in trichotillomania. These neurotransmitters are involved in mood regulation and impulse control. According to the 2022 article from MedlinePlus medications targeting these neurotransmitters, such as selective serotonin reuptake inhibitors (SSRIs), have shown efficacy in reducing symptoms, highlighting the biological underpinnings of the disorder.
3. Brain Structure and Function: Abnormalities in brain regions responsible for habit formation and impulse control, such as the basal ganglia and frontal cortex contribute to trichotillomania. The 2007 study by Feng indicates that these structural and functional differences contribute to the onset and maintenance of trichotillomania, which shows a biological basis for the disorder.

Psychological Causes of Trichotillomania In Teens

1. Anxiety and Stress: High levels of anxiety and stress are common triggers for hair-pulling behaviors. The act of pulling hair serves as a coping mechanism to manage overwhelming emotions.
2. Obsessive-Compulsive Traits: Trichotillomania is classified under obsessive-compulsive and related disorders in the DSM-5. Individuals with this disorder often exhibit obsessive thoughts about hair pulling and compulsive behaviors to relieve these thoughts.
3. Emotional Regulation Difficulties: Teens with trichotillomania often struggle with emotional regulation. According to a 2012 study by Gude, D., et al, “Comprehending Trichotillomania” published in the International Journal of Trichology, hair pulling temporarily relieves negative emotions, which creates a cycle of dependency. 

Social Causes of Trichotillomania In Teens

1. Family Dynamics: Family environment and dynamics play a significant role in the development of trichotillomania. Stressful or chaotic family situations exacerbate hair-pulling behaviors. The 2024 article from GARD holds that supportive family interventions help improve outcomes, showing that family dynamics are a critical factor in the disorder’s development.

2. Peer Influence and Social Pressure: Adolescents are highly susceptible to peer influence and social pressures. Bullying, social rejection, and the desire to conform can contribute to the onset of trichotillomania. 

3. Media and Cultural Factors: The portrayal of beauty standards in media and culture impacts teens’ self-esteem and body image, potentially leading to trichotillomania. Societal pressures and unrealistic beauty standards trigger hair-pulling behaviors as teens struggle to meet these ideals.

How Is Trichotillomania Diagnosed?

Trichotillomania is diagnosed through a combination of a physical examination (hair loss, visible signs of hair pulling and psychiatric evaluation (hair pulling behavior, emotional and functional impact) by a mental health professional, such as a psychiatrist or therapist. According to the 2023 article by Dube B., “What Is Trichotillomania”, from Health, the condition is diagnosed by a physical examination and psychiatric evaluation.

1. Physical Exam: The healthcare provider examines the areas of hair loss, looking for visible signs of hair pulling and any damage to the skin or tissue. This helps rule out other potential causes of hair loss.

2. Psychiatric Evaluation: The provider will ask questions about the person’s hair-pulling behaviors, including when it started, how often it occurs, and the emotional and functional impact. They will assess whether the criteria for trichotillomania are met according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The DSM-5 criteria for diagnosing trichotillomania include:

1. Recurrent pulling out of one’s hair, resulting in hair loss.

2. An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior

3. Pleasure, gratification, or relief when pulling out the hair

4. The disturbance is not better explained by another medical condition.

5. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What Are The Treatment Approaches Of Trichotillomania In Teens?

Treatment approaches for Trichotillomania In teens include psychotherapy (habit reversal training), mindfulness-based stress reduction, and support groups. According to the 2024 article “Trichotillomania”,  from the Association for Behavioral and Cognitive Therapies (ABCT), treatment approaches for trichotillomania include psychotherapeutic approaches using habit reversal therapy (HRT), and medication such as selective serotonin reuptake inhibitors (SSRIs).

Psychotherapy 

1. Habit Reversal Training (HRT): Habit reversal training is a form of cognitive behavioral therapy (CBT), considered the most effective treatment for trichotillomania. It involves identifying triggers for hair-pulling and developing alternative behaviors to replace the pulling. According to the 2024 article from ABCT, this therapy helps individuals understand the contexts in which they pull their hair and create competing responses that are less harmful.
2. Cognitive Restructuring: This aspect of CBT focuses on altering distorted thoughts and beliefs contributing to hair-pulling behavior. By addressing these cognitive distortions, teens can reduce the urge to pull their hair.

Mindfulness And Relaxation Techniques

• Mindfulness-Based Stress Reduction (MBSR): Incorporating mindfulness practices helps teens become more aware of their hair-pulling triggers and develop better control over their impulses. Techniques such as deep breathing, meditation, and progressive muscle relaxation reduce overall stress and the compulsion to pull hair.

Support Groups

• Peer Support: Joining support groups in person or online provides teens with a sense of community and shared experience. These groups offer emotional support and practical advice on managing trichotillomania. Organizations like the Trichotillomania Learning Center, a division of the National Organization for Rare Disorders, provide resources and forums for individuals with the disorder.

What Medications Are Used To Treat Trichotillomania?

Medications used to treat Trichotillomania are selective serotonin reuptake inhibitors and naltrexone, N-Acetylcysteine (NAC), as demonstrated by the 2024 article from ABCT.

Selective Serotonin Reuptake Inhibitors (SSRIs)

These medications, commonly used to treat depression and anxiety, are effective in reducing the symptoms of trichotillomania. While not FDA-approved for treating trichotillomania, SSRIs are highly beneficial in treating the condition.

Selective Serotonin Reuptake Inhibitors (SSRIs) used to treat trichotillomania include:

1. Clomipramine (Anafranil)
2. Fluoxetine (Prozac)
3. Sertraline (Zoloft)
4. Paroxetine (Paxil)

Naltrexone

Naltrexone is an opioid antagonist often used to treat addictive behaviors and has been found to help reduce hair-pulling in some patients. It works by modulating the brain’s response to compulsive behaviors.

N-acetylcysteine (NAC)

This is an amino acid that has shown moderate effectiveness in treating trichotillomania. It is often recommended as a first-line treatment option due to its favorable side-effect profile.

Is Trichotillomania A Type Of Self-Harm?

Trichotillomania is not a type of self-harm, but rather a body-focused repetitive behavior (BFRB). According to the 2017 article by Mouton-Odum S., “Common Myths and Misconceptions about Trichotillomania: Part 2 Functions of Pulling and Treatment”, people with trichotillomania have no intention to harm themselves even when they pull out their hair. Rather, the pulling is emotional and sensory-related.

Trichotillomania is Not Self-Harm

1. Trichotillomania is categorized as a body-focused repetitive behavior (BFRB), not a form of self-harm.

2. The intention behind trichotillomania is not to hurt oneself, unlike self-harm behaviors. The damage caused is an unintended consequence, not the goal.

The DSM-5 explicitly distinguishes trichotillomania from self-harm, stating it is not “better explained by another mental disorder or medical condition (e.g. trichotillomania).

Reasons For Trichotillomania Vs. Self-Harm

1. Trichotillomania is often driven by sensory, emotional, or cognitive factors, like feeling the urge to pull out a hair that feels different or to relieve anxiety.

2. In contrast, self-harm is used as an unhealthy coping mechanism to distract from emotional pain, release tension, or self-punish.

You may also be interested in our other articles such as:

Teen Mental Health: Meaning, Issues, Causes, Symptoms and Effect

Teen Depression: Causes, Symptoms and Treatment

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1. Is Trichotillomania Contagious?

No, trichotillomania is not contagious. The disorder is not infectious and does not spread to others. It is an individual condition that affects the person experiencing it. Rather, it is a mental health condition that involves an irresistible urge to pull out hair from the scalp, eyebrows, eyelashes, or other areas of the body, as demonstrated by the “Trichotillomania (Hair-Pulling Disorder)” from the Mayo Clinic.

2. Is Trichotillomania A Part Of Anxiety?

Trichotillomania is closely associated with anxiety disorders. According to the 2017 Grant J E.,  et al,” Trichotillomania And Co-Occurring Anxiety”, published in the Comprehensive Psychiatry Journal, a majority of people with trichotillomania also have an anxiety disorder.

3. Is Trichotillomania A Choice?

Trichotillomania is not a choice or a simple bad habit, but rather a mental health condition that involves an irresistible urge to pull out one’s hair, as demonstrated by the 2023 article by  Sheikh Z., “Trichotillomania: Understanding the Hairpulling Disorder”, from WebMD.

 4. What Is The Prognosis For Teens With Trichotillomania?

The prognosis varies with individuals; some experience spontaneous remission, while others struggle with chronic symptoms. Early intervention and treatment improve outcomes as demonstrated by the 2022 article from MedlinePlus.

5. Are There Any Emerging Treatments For Trichotillomania?

Emerging treatments include the use of N-acetylcysteine, a glutamate-modulating agent, and novel digital interventions like mobile apps and online therapy, as demonstrated in the 2009 study by Grant JE, et al, “N-Acetylcysteine, A Glutamate Modulator, In The Treatment Of Trichotillomania: A Double-Blind, Placebo-Controlled Study”.

6. How Can You Calm Down Trichotillomania?

According to a 2024 article “ Trichotillomania (Hair Pulling Disorder)”, from the National Health Service, the condition is managed and calmed down by:

1. Squeezing a ball when you feel the urge to pull your hair
2. Taking a soothing bath whenever you feel anxious or stressed out
3. Using a fidgeting toy
4. Wearing a fitting hat or tying a bandana to limit access to the hair

7. What Should I Do If I Suspect My Teen Has Trichotillomania?

Encourage your teen to seek professional help without being judgemental. In addition, offer to facilitate their search for treatment. According to the 2022 article from Healthdirect, seeking treatment early improves the prognosis.

8. Can Drugs Cause Trichotillomania?

Yes, some drugs hold the potential to cause trichotillomania. In the 2013 case study by  Narine C., et, al, “Adderall-induced Trichotillomania: A Case Report”, published in the Innovations in Clinical Neuroscience Journal, a 12-year-old girl presented with symptoms of trichotillomania, which was traced to her Adderal medication.