Trichotillomania (Hair-Pulling Disorder)

Trikotillomania (hair-pulling disorder) is a chronic psychiatric disorder characterized by the repetitive and uncontrollable pulling of hair from the scalp or other body regions. This condition typically begins during adolescence and can lead to significant impairments in psychosocial functioning. The hair-pulling behavior is not limited to the scalp but may also affect eyebrows, eyelashes, beard, and other body areas. The behavior is triggered by an immediate sense of tension, followed by temporary relief after the act of pulling.

Clinical Presentation and Diagnostic Criteria

The diagnosis of trichotillomania is generally based on the patient’s clinical history and observation. According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), for a diagnosis to be made, the behavior of hair pulling must be recurrent, result in noticeable hair loss, and be preceded by increasing tension and followed by a sense of relief. In some individuals, the behavior occurs consciously, while others pull hair automatically without awareness. The act often involves the deliberate plucking of individual hairs using the fingertips, leading to irregular and asymmetrical bald patches on the scalp. Differential diagnosis requires exclusion of dermatological conditions such as alopecia areata.

Epidemiological Findings

The lifetime prevalence of trichotillomania in the general population ranges from 0.6% to 2.4%.^【1】 The disorder is reported more frequently in females than in males.^【2】 The onset typically coincides with adolescence, although cases beginning at earlier ages have been documented.^【3】 However, hair-pulling behaviors observed in early childhood are often transient and may be related to environmental factors.

Psychopathological Foundations

The etiology of trichotillomania is multifactorial. Genetic predisposition, neurobiological differences, neurochemical imbalances, and psychological stressors may all contribute to its development. Neuroimaging studies have identified structural abnormalities, particularly in the right frontal lobe.^【4】 Furthermore, the disorder is associated with deficits in impulse control and emotional regulation. Hair-pulling behavior frequently emerges as a coping mechanism in response to anxiety, stress, or internal tension.

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Comorbid Conditions

Trichotillomania often co-occurs with other psychiatric disorders. These comorbidities include major depressive disorder, Anxiety disorders, eating disorders, and skin-picking disorder (dermatillomania). Coexisting psychiatric conditions can complicate treatment and lead to further declines in quality of life.

Treatment Approaches

The treatment of trichotillomania generally requires a multidimensional approach. Currently, one of the most effective treatments is Habit Reversal Training (HRT), a subtype of cognitive behavioral therapy. This approach aims to help individuals become aware of their hair-pulling behavior, identify triggering situations, and replace the behavior with functionally incompatible habits. Other psychotherapeutic techniques include third-wave therapies such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). These therapies focus on improving emotional regulation and impulse control to promote more lasting recovery.

Trichotillomania is a chronic and recurrent disorder that can cause serious negative consequences in both psychological and social functioning. Increasing awareness during diagnosis and treatment, promoting early intervention, and expanding multidisciplinary approaches are essential. The absence of standardized treatment protocols and patients’ reluctance to seek help due to shame can adversely affect clinical outcomes. Therefore, integrating long-term follow-up and supportive strategies into treatment is recommended.

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