What Causes Trichotillomania?

Trichotillomania is a mental illness in which one’s own body hair (hair, eyebrows, eyelashes, beard, etc.) is repeatedly pulled out. It is a disease that occurs in about 1% of the population and was previously thought to be common in children and females, but recently it seems that the number of adult male patients is increasing. The reason for the onset of trichotillomania is not yet clear, but it is thought to have the following causes.

Mental stress and frustration

The main causes are attributed to stress and frustration. However, on the other hand, some patients unknowingly pull their hair when they are bored or want to dispel their loneliness.

<< Many cases of trichotillomania >>

  • Stress due to changes in the environment such as transfer or transfer
  • Stress from relationships such as bullying and overly strict parental discipline
  • Anxiety about studying for entrance exams and job hunting
  • Hormone imbalance (menstruation / menopause)


Recent studies have shown that Hoxb8, Sapap3, and Slitrk5 gene-deficient mice perform repeated scratching (called grooming) until their hair peels off. Since this behavior is very similar to that of trichotillomania patients, it has been pointed out that these genes may be involved in trichotillomania.

Complications and similar symptoms of trichotillomania

Complications of Trichotillomania Some patients with trichotillomania eat the plucked hair. However, even if the hair is swallowed, it is not digested in the stomach, so it mixes with gastric juice and food and becomes a hard solid like stone. This is called “hair bezoar”. Hair gastroliths can cause nausea, vomiting, constipation, and in severe cases, intestinal obstruction, which can lead to death without surgery.

Similar symptoms of trichotillomania

Excoriation is a symptom similar to trichotillomania. Excoriation is a type of obsessive-compulsive disorder that causes or scratches your skin. When it becomes excessive, it is serious due to scarring due to skin plucking (the ulcer does not heal completely and remains as a scar with unevenness and pigmentation), infection, excessive bleeding, and bacteria entering from the wound. Bloodstream infections (sepsis) may occur.

How to deal with trichotillomania

For children

If your child has trichotillomania, the remedy is for your parents to listen carefully. Children can rest assured that they will be close to their feelings, such as whether they are having trouble at school or cram school, or whether they feel lonely because they have been alone at home for a long time. When you are released from stress and anxiety, it seems that it will heal naturally in many cases. In addition, it is also effective to change the hairstyle to one that is difficult to pull out, such as shortening the hair for boys and braiding the hair for girls.

For adults

The older the onset, the longer the treatment often, so early consultation is recommended. It seems that they are often treated in psychosomatic medicine rather than dermatology. If you are uncomfortable, you can start with free internet or telephone counseling. In many cases, I try to solve the problem by facing my feelings about why I am pulling my hair. Also, as in the case of children, it is one of the effective measures to make the hairstyle difficult to pull out and to wear a wig or hat.

Specific treatment for trichotillomania

Specific treatments are cognitive behavioral therapy (psychotherapy) and drug therapy.

Cognitive Behavior Therapy

It is a treatment method that makes you notice the habit of thinking that is difficult for you to notice and improves the problematic behavior (in this case, the behavior of pulling out your hair). Let’s support the people around you without taking a negative attitude. Specifically, we will proceed with the treatment as follows. (1) Awareness Training When you start pulling your hair, you will be aware of your unconscious hair pulling behavior by recording your current psychological state each time. By recording in writing, the patient will be able to recognize and deal with the situations, times, and emotions that are likely to cause symptoms in daily life. (2) Competing Response Training When you are about to pull out your hair, you will be trained to take actions against it. For example, you can suppress the desire to pull out your hair by taking other actions, such as squeezing your palm or holding your armpits to prevent your arms from moving.

Drug therapy

①: N-Acetylcysteine

It works to regulate the amount of neurotransmitter (glutamic acid) that affects mood. You can easily take it as a supplement.

②: SSRI (selective serotonin reuptake inhibitor)

By increasing serotonin in the brain, it relieves the patient’s anxiety and depressed mood, and improves the stress that causes trichotillomania. Side effects are relatively few, but nausea, diarrhea, and sleep disorders may occur. In addition, withdrawal symptoms (dizziness, sweating, nausea, convulsions, etc.) may occur if you miss a dose or stop suddenly at your own discretion.

③: Clomipramine is a drug classified as a tricyclic antidepressant. By increasing serotonin and noradrenaline in the brain, symptoms such as decreased motivation, anxiety, and insomnia are alleviated and stress is improved. Tricyclic antidepressants are generally more effective but more prone to side effects. The main side effects include strong drowsiness, thirst, constipation, dizziness and light-headedness, nausea and palpitation.



1) Gregory JEverettet al.Advances in The Treatment of Trichotillomania (Hair Pulling Disorder), Dermatol Ther. 2020 Jun12, e13818

2) Expert Consensus Treatment Guidelines “Body-Focused Repetitive Behaviors Hair Pulling, Skin Picking, and Related Disorders” THE TLC FOUNDATION


June 2024