population. However, it now seems that it is at least as common as another nervous habit, nail-
biting. I see more people with this disorder than most clinicians because I specialize in treating
anxiety disorders such as Obsessive Compulsive Disorder. Trichotillomania is considered by
many therapists to be a form of compulsive behavior, but this is still arguable. It sometimes
occurs among people with several other disorders such as schizophrenia and mental retardation,
but most people who compulsively pull their hair are otherwise normal, psychologically sound
people with a nervous habit. It occurs frequently in children, some as young as 1 year old.
Trichotillomania is similar in operation to other nervous habits such as nail biting, thumb sucking,
head jerking, and shoulder jerking, and other nervous tics.
Most people find hair pulling to be emotionally distressing and for some it is a major tragedy in
their lives. Children who pull out their hair are often highly criticized by their parents and peers to
the point that they become very self-conscious and ashamed. I have treated some people who
have pulled out up to 90% of the hair on their heads, others who have pulled out their eyebrows
to the point they no longer grow back and others who pull out their eyelashes and pubic hair.
The very first person I treated for this problem was a 34 year old editor for a publishing
company. When I first saw her I thought she was coming to see me for help with the emotional
strain of having cancer - she looked like she had been through chemotherapy and her hair had
just started to grow back.
There have many theories about how hair pulling begins and why. There is a possibility of a
genetic component, but nothing has been proven as yet. Family studies have shown that certain
parenting styles may have something to do with children pulling hair. However, no theory has
been established with any certainty. The preponderance of evidence seems to indicate it is an
inherited disorder. All of the people I have treated have had a relative (parent, aunt, uncle,
grandparent) who had a nervous tick of some sort. What is inherited is a tendency to react to
stress with some sort of tic. Genetics are not destiny. I consider hair pulling to be a nervous habit
that originally starts as a normal reaction to some sort of stress. This could be a traumatic event,
constant criticism and/or demands from parents or others, a physical injury, etc. It often
accompanied by other anxiety responses such as phobias or Obsessive Compulsive Disorder. It
seems to be similar to compulsions in many ways, particularly in that people want to stop doing
it but seem unable to do so despite their best efforts.
The most tragic thing about trichotillomania is that it readily responds to treatment. I have helped
some people overcome this disorder in less than 4 sessions, although an average of 8 - 10
sessions is more common, particularly if there are other anxiety disorders accompanying the hair
pulling. For those who for various reasons may not respond to behavioral treatment there are
several medications that have shown effectiveness in helping people control this disorder.
Trichotillomania seldom disappears on its own. Don’t wait to get treatment. Help is available.
