Trichotillomania: are you pulling out your hair?

Trichotillomania: are you pulling out your hair?

By Cynthia Wairimu

As a child I would play with hair just because. I would sit and as I watch something or get engrossed in another, I would find myself playing with one or two strands of hair; it was ritualistic. As I grew up, with tension and anxiety from my studies, I found myself pulling out whole braids from the scalp of my head, mainly at the back – without feeling any pain mind you.

It was weird; the back would not result in pain but the front would. I would not be comfortable until I pulled out a strand from the root. The root having the bulb is what would bring me satisfaction; in fact, I would chew on that bulb every time I got one. The condition got worse while I prepared to sit my final exam, and, as I would read and I would come to find myself surrounded by lots of hair all over me. It resulted in me getting a bob cut hairstyle. When the condition got out of hand, I had to cut my hair. This stopped me from gripping the hair to pluck it. However, as it grew back, so did my urge to pull it out.

This is a clear indication of trichotillomania – also known as the hair pulling disorder – which many suffer from without knowing it. It is a mental disorder that involves a compulsive and irresistible urge to pull out hair, from the scalp, or any other area where hair grows; eyebrows, armpits, groin, beard or moustache.

Usually, one feels the needs to pull out hair, building up tension until they pull it out and experience relief once it happens. It affects girls more than boys and is more common among young adults and teenagers, although it is not unheard of amongst older folk.

The hair pulling could be conscious or subconscious – that is, focused, meaning the person intentionally pulls out their hair to garner some relief, or automatic, where the person doesn’t even realise they are doing it, say while engrossed on a tv show or reading a book. In other situations, it could be both, where the person picks some specific type of hair and pulls it and uses it to play or to chew it especially when faced with “ideal” conditions such as resting your head on a pillow.

Amongst its most common symptoms include: one will notice hair patches on the scalp, and the hair pulling may shift to different areas with time; a tendency to chew or bite pulled out hair, finding oneself playing with pulled out hair; an accompanying ritual to the hair pulling, such as the urge kicking in once in a certain position, or in a certain room; an increased sense of tension right before the hair is pulled out and relief, after it’s done; and accompanying habits of lip chewing, nail biting, skin picking.

So, what causes trichotillomania?

Negative feelings mostly such as boredom, loneliness, anxiety, could trigger hair pulling. On the other hand, positive feelings also play a part, especially when the action leads up to relief then one may pull out their hair simply to feel that satisfaction, and not because they are angry or bored.

Other instances that may cause it include: using it as a way to self-harm like we see when people cut themselves to experience release and relief from emotional pain; imbalance of chemicals in the brain, and change of hormones as is experienced during puberty.

This disorder becomes a major challenge if the hair pulling is followed up by eating the hair as well. This causes the hair to enter the digestive tract which then interferes with feeding and digestion which is dangerous and self-debilitating and can lead up to death.

Emotional distress also makes the condition worse. Social work and functioning may be affected as some will experience shame from how they look, and you might find disguises in the shape of wigs, beanies, head scarfs to hide hair loss. Of course, one will experience hair damage and skin problems say from infection of the scalp, to irritation.

Treatment and Management

Personally, to manage it, I realised I hated the feel of hair gel on my hands. It would irritate me, so I would apply ample amounts of it to my hair and any time I would start to touch it, I would get irritated and stop. This helped me manage the hair on my scalp.

Therefore, if you feel you might be experiencing such, it is crucial to see a general practitioner first, so as to eliminate any other causes of hair loss. If trichotillomania is found to be the problem then a therapist should be involved. Usually, cognitive behavioural therapy is applied, which includes, habit reversal training. This is pretty much replacing a bad habit with one that isn’t harmful. For instance, when the urge comes, squeezing a stress ball instead will be encouraged.

Figuring out what the triggers are is important. Therefore, keeping a diary comes could come in handy. Record every time you pull out your hair and the events leading up to that moment. This will help figure out what happens right before the urge comes on and what can be done to change the resulting reaction. Letting loved ones know will help with a support system that will notify you and notice when you are pulling out your hair and help you stop. Apparently, those who have spoken up on the habit have had a reduced urge to pull out their hair.

There are those who prefer to remain quiet on the matter as they feel embarrassed about the patches on the scalp or the uneven hair growth and will tend to hide it and if the urge becomes too much, they will aim for areas where it is not immediately obvious, such as the groin. Some of these can help manage the condition, using a stress ball, cutting hair short, plastering your fingers, exercise, easing stress and anxiety in healthy ways.

During the coronavirus lockdown period, there have been reports of increasing hair pulling and thus Trichotillomania Support, an online charity where you can meet experts and people with the same condition, has been helping those in need. According to Michelle Harper from the program, the lockdown has definitely had an impact on the mental health of many people, and an increase in levels of depression, stress and anxiety could increase the urges to pull that a person with trich experiences.

“Uncertainty about the future, finances, or a fear of becoming unwell, combined with lack of things to distract themselves with and many support services being unavailable, means that a lot of people are finding this to be a very tough time,” she says. (

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