Trichotillomania is hair loss from compulsive pulling or twisting of the hair until it breaks off.

Trichotillosis; Compulsive hair pulling

Trichotillomania is a type of compulsive behavior. Its causes are not clearly understood.

It may affect as much as 4% of the population. Women are four times more likely to be affected than men.

Symptoms usually begin before age 17. The hair may come out in round patches or across the scalp. The effect is an uneven appearance. The person may pluck other hairy areas, such as the eyebrows, eyelashes, or body hair.

These symptoms are usually seen in children:

• An uneven appearance to the hair
• Bare patches or all around (diffuse) loss of hair
• Bowel blockage (obstruction) if people eat the hair they pull out
• Constant tugging, pulling, or twisting of hair
• Denying the hair pulling
• Hair regrowth that feels like stubble in the bare spots
• Increasing sense of tension before the hair pulling
• Other self-injury behaviors
• Sense of relief, pleasure, or gratification after the hair pulling

People with this disorder often will first seek the help of a doctor who treats skin problems (dermatologist).

A piece of tissue may be removed (biopsy) to rule out other causes, such as a scalp infection, and to explain the hair loss.

Experts don't agree on the use of medication for treatment. However, naltrexone and selective serotonin reuptake inhibitors (SSRIs) have been shown effective in reducing some symptoms. Behavioral therapy and habit reversal may also be effective.

Typically, trichotillomania is limited to younger children who tend to outgrow the behavior. For most, the hair pulling ends within 12 months. Children who start pulling hair early (before age 6) tend to do better than those who start later.

People can have complications when they eat the pulled-out hair (trichophagia). This can cause a blockage in the intestines or lead to poor nutrition.

Early detection is the best form of prevention because it leads to early treatment. Decreasing stress can help, because stress may increase compulsive behavior.

Morelli JG. Disorders of the hair. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 661.

Kratochvil CJ, Bloch MH. Trichotillomania across the life span. J Am Acad Child Adolesc Psychiatry. 2009;48:879-883.