Trichotillomania
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Trichotillomania is a mental disorder from the group of obsessive-compulsive and related disorders, characterized by a recurring, difficult-to-control compulsion to pull out hair from various areas of the body. It most commonly affects the scalp but can also involve eyebrows, eyelashes, beard, armpit, or pubic areas. The result is visible hair loss, thinning, or bald patches, often accompanied by shame, guilt, and a significant reduction in quality of life. The disorder is chronic, with periods of remission and relapse, and its etiology is multifactorial—encompassing neurobiological, psychological, and environmental components. Trichotillomania affects both children and adults, more frequently women, and requires an interdisciplinary approach that combines psychiatry, psychotherapy, and dermatology.
Trichotillomania – what is it
Trichotillomania (English: hair-pulling disorder) has been formally classified as a distinct disorder in current psychiatric classifications. Its essence is not the hair loss itself, but the compulsive behavior that:
- occurs despite awareness of its harmfulness,
- provides temporary relief or tension reduction,
- is difficult or impossible to control.
From a neurobiological perspective, the disorder is associated with dysregulation of systems responsible for:
- impulse control,
- reward processing,
- stress response.
In many patients, trichotillomania coexists with:
- anxiety disorders,
- depression,
- obsessive-compulsive disorders,
- tics or other behaviors from the BFRB (body-focused repetitive behaviors) group.
It is important to distinguish trichotillomania from:
- alopecia areata,
- telogen effluvium,
- inflammatory scalp diseases.
In these cases, hair loss is the result of a disease process, not compulsive behavior.
Trichotillomania – symptoms
The clinical picture of trichotillomania is complex and includes both dermatological symptoms as well as psychological and behavioral ones. **Dermatological Symptoms** - Irregular patches of thinning or complete hair loss, - Hairs of varying lengths within a single area, - Lack of inflammatory features typical of skin diseases, - Follicle damage with prolonged progression, - Secondary skin changes: irritations, erosions, scars. **Behavioral Symptoms** - Repetitive hair pulling with hands or tools, - Rituals preceding the act (e.g., searching for the "perfect" hair), - Automatic episodes (without full awareness) or conscious ones, - Accompanying behaviors such as twisting, biting, or swallowing hair. **Psychological Symptoms** - Increasing tension before pulling hair, - Short-term relief after the act, - Shame, guilt, low self-esteem, - Avoidance of social situations, - Symptom masking (hairstyles, makeup, accessories). Untreated trichotillomania can lead to permanent follicle damage and severe psychosocial consequences.
Trichotillomania – How to Treat
Treating trichotillomania requires a multidirectional approach, as simply targeting the skin and hair does not address the root cause of the disorder.
The foundation of treatment is psychotherapy, particularly:
- cognitive-behavioral therapy (CBT),
- habit reversal training,
- emotion regulation and stress reduction techniques.
The goals of therapy are:
- identifying behavior triggers,
- learning alternative responses,
- improving impulse control.
Pharmacological Treatment
In selected cases, especially with the coexistence of other mental disorders, pharmacological treatment is used under the supervision of a psychiatrist. Pharmacotherapy does not replace psychotherapy, but it can support it.
The role of the dermatologist is to:
- assess the condition of the scalp and hair follicles,
- prevent inflammatory complications,
- support skin regeneration.
It should be clearly emphasized:
dermatological and aesthetic procedures do not treat the cause of trichotillomania, but they can improve the condition of the skin and hair during remission, enhancing the effect of psychological therapy.
Treatments for trichotillomania
Treatments used for patients with trichotillomania have a supportive nature and should be considered only:
- after a correct diagnosis has been made,
- in conjunction with psychological or psychiatric treatment,
- during a phase where hair pulling is limited or controlled.
Goals of the Treatments
- improvement of scalp microcirculation,
- stimulation of hair follicles,
- regeneration of damaged skin,
- supporting hair regrowth where there has not been permanent follicle destruction.
- scalp stimulating treatments with regenerative and anti-inflammatory effects,
- scalp mesotherapy with preparations that improve the condition of hair follicles,
- therapies supporting microcirculation and cellular metabolism,
- procedures that improve the quality of the skin in thinning areas.
- lack of impulse control for hair pulling,
- active skin damage,
- presence of scars with permanent follicle destruction.
In clinical practice, these treatments are regarded as a complementary element to comprehensive treatment, not as an independent method of therapy. For some patients, improving the appearance of the skin and hair can be motivating, enhancing engagement in psychological treatment and maintaining remission.
