Symptoms

Signs and symptoms of trichotillomania often include:

• Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time
• An increasing sense of tension before pulling, or when you try to resist pulling
• A sense of pleasure or relief after the hair is pulled
• Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
• Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
• Biting, chewing or eating pulled-out hair
• Playing with pulled-out hair or rubbing it across your lips or face
• Repeatedly trying to stop pulling out your hair or trying to do it less often without success
• Significant distress or problems at work, school or in social situations related to pulling out your hair

Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For people with trichotillomania, hair pulling can be:

• Focused. Some people pull their hair intentionally to relieve tension or distress — for example, pulling hair out to get relief from the overwhelming urge to pull hair. Some people may develop elaborate rituals for pulling hair, such as finding just the right hair or biting pulled hairs.
• Automatic. Some people pull their hair without even realizing they're doing it, such as when they're bored, reading or watching TV.

The same person may do both focused and automatic hair pulling, depending on the situation and mood. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Trichotillomania can be related to emotions:

• Negative emotions. For many people with trichotillomania, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, fatigue or frustration.
• Positive feelings. People with trichotillomania often find that pulling out hair feels satisfying and provides a measure of relief. As a result, they continue to pull their hair to maintain these positive feelings.

Trichotillomania is a long-term (chronic) disorder. Without treatment, symptoms can vary in severity over time. For example, the hormonal changes of menstruation can worsen symptoms in women. For some people, if not treated, symptoms can come and go for weeks, months or years at a time. Rarely, hair pulling ends within a few years of starting.

When to see a doctor

If you can't stop pulling out your hair or you feel embarrassed or ashamed by your appearance as a result of your hair pulling, talk to your doctor. Trichotillomania is not just a bad habit, it's a mental health disorder, and it's unlikely to get better without treatment.