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ICD-10 F63.3
ICD-9 312.39
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Trichotillomania - Definition

Trichotillomania (TTM) or Hair pulling(also known as "Trichotillosis"[1]), or "trich" as it is commonly known, is an impulse control disorder or form of self destructive behavior characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches.[2]

Trichotillomania is classified in the DSM-IV as an impulse control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the trich. The name derives from Greek: tricho- (hair), till(en) (to pull), and mania.

Trichotillomania: Description Most TTM sufferers live relatively normal lives, except for having bald spots on their head, among their eyelashes, or brows. eyelashes have been reported to grow back thinner or in much lesser amounts. Many clinicians classify TTM as a mental disorder, though the classification is debatable. Some clinicians classify TTM as a form of obsessive-compulsive disorder. Some classify TTM as a form of self-harm. Others say that TTM is no more a mental disorder than is any other habitual behavior, such as nail biting. Many TTM sufferers have relatively normal work and social lives; and TTM sufferers are not any more likely to have significant personality disorders than anyone else. A practice related to TTM is trichophagia, in which hairs are sucked and/or eaten. In extreme cases, this can lead to the development of a hairball (trichobezoar) in the abdomen, a serious condition in humans; see Rapunzel syndrome.

Trichotillomania - History of the disorder Trichotillomania has been mentioned as a disease in very early records in history.

Trichotillomania - Epidemiology

Trichotillomania - Risk factors

  • Trichotillomania - Known evidence of risk factors
  • Trichotillomania - theories of possible risk factors

Trichotillomania - Etiology

  • Trichotillomania - Known evidence of causes
  • Trichotillomania - Theories of possible causes

Trichotillomania - Diagnosis & evaluation

Trichotillomania: Treatment

Trichotillomania is classified as an Obsessive Compulsive Spectrum Disorder. Compulsive Spectrum Disorders are obsessive compulsive qualities that are related and similar to that of Obsessive-compulsive disorder.

Habit Reversal Training

One form of treatment for Trichotillomania is Habit Reversal Training. Many patients who pull their hair don’t realize that they are doing this; it is a conditioned response. With Habit Reversal Training doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. Patients who feel the urge to pick at their hair are taught to visualize something that will get their mindset off picking at their hair. Once they are aware of what they are doing then they are able to focus and stop themselves from the urge of picking.

Patients are also often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes.

In most cases, picking and or pulling hairs does not go away, but often improves.

Exposure and Response Techniques (ERT)

Stimulus and Control Techniques


Selective seretonin reuptake inhibitors (SSRIs) are commonly used in the treatment of trichotillomania. Antidepressants have been shown to be effective in treating both Obsessive-Compulsive Disorder and trichotillomania.

There have been recent clinical trials of drug treatment for trichotillomania, for example using anafranil, prozac, and lithium. One should use care in choosing a therapist who has specific experience and insight into the condition, lest one be overdiagnosed or overmedicated. Prozac and other similar drugs, which some professionals prescribe on a one-size-fits-all basis, tend to have limited usefulness in treating TTM, and can often have significant side effects.

  • Trichotillomania - Outcome studies
  • Trichotillomania - Treatment protocols
  • Trichotillomania - Treatment considerations
  • Trichotillomania - Evidenced based treatment
  • Trichotillomania - Theory based treatment
  • Trichotillomania - Team working considerations
  • Trichotillomania - Followup

Trichotillomania: For people with this difficulty

  • Trichotillomania - User:how to get help
  • Trichotillomania - User:self help materials
  • Trichotillomania - User:useful reading
  • Trichotillomania - User:useful websites
  • Trichotillomania - User:user feedback on treatment of this condition

Trichotillomania - For their carers

  • Trichotillomania - Carer:how to get help
  • Trichotillomania - Carer:useful reading
  • Trichotillomania- Carer:useful websites

Hair pulling - Academic support materials

  • Trichotillomania - Trichotillomania: Academic: Lecture slides
  • Trichotillomania - Academic: Lecture notes
  • Trichotillomania - Academic: Lecture handouts
  • Trichotillomania - Academic: Multimedia materials
  • Trichotillomania - Academic: Other academic support materials
  • Trichotillomania - Academic: Anonymous fictional case studies for training

Hair pulling - For the practitioner

  • Hair pulling - Practitioner:further reading
  • Trichotillomania - Practioner:useful websites


  1. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.
  2. Freedberg, et. al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.