Trichotillomania (Hair-Pulling Disorder): Symptoms, Causes, and Treatment

Trichotillomania (TTM) is an obsessive-compulsive related disorder characterized by recurrent hair pulling causing hair loss and distress.

Diagnostic Criteria (DSM-5)

• Recurrent pulling → hair loss.
• Repeated attempts to decrease/stop.
• Clinically significant distress/impairment.
• Not due to another medical/dermatologic condition or mental disorder.

Clinical Features

• Onset: Mean age 10–13; peak 12–17.
• Sex: F:M ≈ 9:1 in clinical samples (less skewed in community).
• Sites: Scalp (75%), eyebrows (50%), eyelashes, pubic, limbs.
• Styles: Focused (ritualistic, tension relief) vs. automatic (unaware, during sedentary activities).

Comorbidities

• OCD, anxiety, depression, BFRBs (skin picking), ADHD, ASD.

Treatment

• First-line: Habit Reversal Training (HRT) – awareness, competing response, social support.
• CBT variants: ACT, DBT, Comprehensive Behavioral (ComB) model.
• Medication: N-acetylcysteine (NAC) 1200–2400 mg/day (best evidence); SSRIs (if comorbid anxiety/depression); olanzapine (refractory).

Prognosis

Chronic waxing/waning. Early intervention improves outcomes. Support groups (TLC Foundation) valuable.