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Bill WhiteBill White
A blog about mental and emotional health

Let's Learn: Trichotillomania (Part 1)

Bill White Updated: Nov 24th 2010

Trichotillomania, what I'll refer to as trich, is a fascinating, albeit brutal, emotional/mental health disorder. It doesn't get the press it deserves, so how 'bout we take a peak? We'll begin with this first in a series of two articles.

girl with hands in her hairTrichotillomania is all about hair-pulling behavior. The preferred sites are the scalp, eyebrows, and eyelashes. But hair on the face, nose, pubic and perirectal areas, chest, arms, and legs are fair game. Most often used in the act of pulling are fingers, tweezers, pins, and other creative instruments.

At its worst, the pulling behavior can become so intense and chronic that it leads to very noticeable bald spots. And in some ten percent of trich cases the pulled hair is eaten (trichophagia), causing a potentially dangerous bezoar - a fancy medical term for, in this case, a hairball.

A trich episode is often induced by a stressful event or mood situation. However, an episode may spontaneously emerge in the midst of calm. Regardless, the behavior is generated by an urge. And a sense of relief is often realized after the urge has been acted upon.

Though trich behaviors can be conscious acts, they're very frequently performed unconsciously - almost as though the individual is in a trance. In most cases, trich doesn't result in a significant compromise in emotional and mental functioning; however, the social ramifications may be severe. I mean, we're dealing with bald spots and, perhaps, wigs, and creative hairstyles and make-up schemes.

Sadly, peers, friends - even family members - may find it difficult to be socially associated with a trich sufferer. And the self-esteem impact of that bit of reality can be devastating.

Trich's average age of onset is between the ages of nine and fourteen, and it's much more prevalent in the first twenty years of life. It presents 75-95% of the time in females. It's thought that 5% of the world's population is affected by trich. However, that figure may be light because stigma often results in trich sufferers keeping their circumstances to themselves.

Trichotillomania has been recognized as a disorder for only about twenty years. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) categorizes trich as an impulse control disorder. That would make it akin to troublesome nail-biting, fire-setting, stealing, gambling, skin-picking, and explosive behavior.

But some find trich similar to obsessive-compulsive disorder (OCD), so they'd consider it an anxiety disorder. Others believe trich is a tic disorder, even an addiction.

Well, we've laid a nice foundation, so let's tie a bow on Part 1. Come on back tomorrow and we'll discuss treatment strategies and techniques.


Editor's Note: Allan Schwartz, Ph.D. briefly examined this topic back in November 2006 and that post is still receiving comments several times a month now. Those interested in reading personal stories from some of the readers who have commented can check out that post here.


Bill White

After enduring decades of anxiety, depression, and alcoholism; Bill made it out of the woods. He found his life’s passion along the way, earned his counseling credentials, and is ready to lend a hand. Visit his blog at, and you can contact Bill at

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