• banner image

    Trichotillomania and BFRB’s

    Trichotillomania, or “hair pulling”, is the repetitive pulling out of one’s hair. Often referred to as “trich,” it usually begins in late childhood or early adolescence and occurs equally among boys and girls. Without treatment it can be a lifelong, chronic condition with the cases that persist into adulthood typically women (80-90%). People with trichotillomaniarepetitively pull their hair out at the root from places like the scalp, eyebrows, eyelashes, arms and legs, or pubic area.Some people with the condition pull large handfuls of hair while other people pull out their hair one strand at a time. Either way, both can result in bald patches on the scalp or eyebrows, or a lack of eyelashes, all of which are often socially debilitating and humiliating. Individuals with trich might inspect or play with the strand after pulling it out with approximately half putting the hair in their mouths after pulling it. Some people are very aware of their pulling while others seem not to realize what they are doing, lie driving on “autopilot.”  For someone with trich, resisting the urge to pull out their hair feels as hard as resisting the urge to scratch a very itchy itch. It is far from a bad “habit” that one can just “stop.” Some people with trich report an urge to pull almost like an itch or feeling in their scalp, with the pulling being the only way to get “relief.” Some people report a brief feeling of satisfaction following the pulling.

    BFRB’s (Body Focused Repetitive Disorders) include skin picking. Most people who engage in BFRBs also experience some degree of shame, secrecy, and isolation.

    Signs and Symptoms of Trichotillomania

    Trichotillomania is currently classified as a disorder related to obsessive compulsive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and include:

    • Recurrent hair pulling, resulting in hair loss
    • Repeated attempts to decrease or stop the behavior
    • Clinically significant distress or impairment in social, occupational, or other area of functioning
    • Not due to substance abuse or a medical condition (e.g., dermatological condition)
    • Not better accounted for by another psychiatric disorder


    Social and Emotional Consequences

    People with trichotillomania may feel embarrassed, frustrated, ashamed, or depressed about it. They often worry what others will think or say and avoid social situations they might otherwise enjoy for fear of being called out on their trich. They might feel nagged by people who don’t understand that they’re not doing this on purpose, and it is not easy to “just stop.” The severity of hair pulling varies widely, from thinning or bald spots to being completely bald. Many people with trich have noticeable hair loss, which they attempt to camouflage with hair styles, scarves, wigs, makeup or hats.  People with trich usually try to hide the behavior from others, even their families, which can make it very difficult to get help. Trich can be affected by a wide range of emotions including anxiety, boredom, frustration, excitement and depression.


    Treatment for Trich and BFRB’s

    Treatment includes Cognitive Behavioral Therapy (CBT) focusing on identifying thoughts, feelings and behaviors and how they influence one another. There are a number of different treatment approaches for BFRBs that fall under the umbrella of CBT including habit reversal training (HRT) and comprehensive behavioral treatment (ComB).  Sometimes medication is prescribed, in combination with therapy.


    For more information on Trichotillomania and BFRB’s please visit www.bfrb.org.