Background Information

Hair Pulling and Resultant Hair Loss

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The Facts

Most sufferers with Trichotillomania are female. 1 or 2 people in 50 pull their hair at some stage of their life. In the United States the figures are similar, with one US study finding that as many as 6 out of every 1,000 students developed Trichotillomania but that many of them were able to stop again once exam stress was over.

Trichotillomania belongs to a group of impulse control disorders. Put simply – you don’t want to pull but you can’t help yourself. Once a hair root has been plucked several times it desensitizes, just as when plucking eyebrows or leg and bikini-waxing. This explains why pulling sites get wider and wider as the feeling of relief is lost from the original area.

Hair-pulling may provide a short-term distraction from immediate worries such as depression, anxiety, dependency or anger - but the pulling may then fuel a new cycle of all these feelings. It may create a vicious circle that is difficult to manage. Major life events such as an abusive home, bullying, divorce or death may trigger Trichotillomania.

Trichotillomania symptoms

Symptoms signs and side-effects of Trichotillomania

  • an irresistible urge to pull hair
  • recurrent pulling results in noticeable hair loss
  • there is an increasing sense of tension immediately before pulling out the hair or when trying to resist an attack
  • there is pleasure, gratification or relief of tension when pulling
  • pulling from more than one site on the body (not necessarily)
  • feeling of guilt afterwards
  • knowing that if stopped there would be a benefit


Triggers for hair pulling

  • looking for hairs that feel different - thicker, coarser or wrong
  • hair that is the “wrong color”
  • ritualized pulling that continues until the “right” hair has been found or pulled


Pulling is 5 to 10 times more common in girls around the ages of 12 and 13 than boys. By adulthood, approximately 12 females to every one male seek help for Trichotillomania. Many tend to hide their behaviour and suffer in isolation for years because of feelings of shame, hopelessness, embarrassment and depression.

The length of an attack can vary greatly, with people pulling for anything from just a few minutes and a few hairs to severe episodes lasting hours or even the whole night, stripping the scalp.

The condition may affect a whole family - with the puller being the focus of much emotion and attention, much of it not entirely positive. Trichotillomania patients often report that their condition is not understood by both family members and the medical community.

Origins of Trichotillomania and Theories About It

Theories to explain the development of Trichotillomania suggest a combination of different factors. These factors could be genetic possibilities, chemical imbalances in the brain due to significant traumatic events, or developmental events in the womb. The fact that some antidepressant drugs can relieve the urge to pull suggests an underlying miscommunication of chemical messengers (neurotransmitters) in the brain.

Hair pulling is as old as time. It is mentioned in the Bible (Job, Ezra 9, verse 3), in the writings of Hippocrates the Greek father of medicine which dates from 400 years BC and in Homer’s Iliad. In religion, the Jain sects of India still require devotees to pull out every hair on their head to help them reach spiritual awareness via pain.

The term Trichotillomania (a combination of three Greek words) was first used in 1889 by a French dermatologist Hallopeau after encountering a young male patient who tore out every hair on his body in response to an intense itch.


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