Is Trichotillomania Really a Type of OCD?
Do you often find yourself compulsively pulling or tugging at your hair? If so, you may be suffering from trichotillomania, an impulse control anxiety condition that involves an involuntary, recurrent urge to pull out your hair. Trichotillomania can involve any part of the body that has hair, such as your armpits, scalp, legs, arms, eyebrows, genital area, eyelashes, and even eyebrows.
People, who struggle with this condition know that hair-pulling can cause negatively affect their self-esteem and self-confidence, and health and well-being, but are unable to stop their urges to engage in this compulsive behavior. Most people with trichotillomania perform this ritual when they are overwhelmed, tired, stressed, anxious, and/or upset. Hair-pulling is used as a coping strategy – to ease their emotional distress.
Trichotillomania can be extremely embarrassing, upsetting, and frustrating, however, please understand that you are not alone. In other words, you are not an anomaly. There is help available, you just have to reach out to it. With the right treatment, you can stop the hair-pulling and resume your life.
If you are wondering if trichotillomania is a type of OCD, you have come to the right place, because in this article, I will explain what trichotillomania is, how it is connected to OCD, and what you should do if you think you have it.
What Exactly is Trichotillomania?
As mentioned above, trichotillomania is a hair-pulling impulse control anxiety condition. In other words, people, who struggle with this condition have uncontrollable urges to pull or tug at their hair. Trichotillomania can lead to baldness and low self-esteem and self-confidence.
People with this condition tend to deal with stress, boredom, anxiety, and emotional distress by pulling at their hair. It is an unhealthy coping mechanism. Trichotillomania is also linked to other mental health conditions, such as depression, bipolar disorder, schizophrenia, PTSD, social anxiety, generalized anxiety, panic attacks, and obsessive-compulsive disorder (OCD).
Is Trichotillomania a Type of OCD?
Yes, it is – or at least that is the general consensus.
Because, trichotillomania involves an obsession (i.e., intrusive thoughts about or a “fixation” on one’s appearance or about pulling out one’s hair) and a compulsion (i.e., pulling out one’s hair to ease stress and anxiety), it is considered, by most, to be an anxiety condition, and specifically, a type of OCD. This condition is referred to as “trichotillomania OCD.”
Keep in mind, however, that some researchers believe that trichotillomania is not the same as OCD, based on differences between the two conditions. These individuals equate trichotillomania to an impulse control condition – not OCD. Still, the majority opinion is that trichotillomania is a type of OCD because it involves obsessions and compulsions.
What Causes Trichotillomania?
There are several possible causes of trichotillomania, such as:
- Chronic or Extreme Stress
Chronic or extreme stress can signal to your brain to produce extra amounts of cortisol, the “stress hormone.” Cortisol manages your body’s reaction to stress by increasing your self-awareness and boosting your energy. Thus, high levels of stress for long periods can increase your risk of engaging in compulsive behaviors like pulling at your hair.
- Genetics or a Family History of Anxiety or OCD
Genetics have been tied to trichotillomania (OCD). Researchers have found that this anxiety condition runs in families, which suggests that there may be hereditary. Studies also indicate that people with a close familial tie to someone, who is suffering or who has suffered from an anxiety condition, mood disorder, tics, habits, OCD, or another mental health condition, have a higher risk of developing trichotillomania than someone who does not have the family medical history.
- Brain Chemistry Changes
Neurotransmitters (chemical messengers in the brain) like serotonin and dopamine appear to contribute to the development and progression of trichotillomania. Studies also suggest that brain chemical changes (i.e., reduced gray matter in the brain) is linked to compulsive behaviors, in general, and specifically, OCD.
- Environmental Factors
Some people develop trichotillomania after experiencing a trauma or watching someone else pull or tug at his or her hair. Thus, environmental factors appear to contribute to the development and progression of trichotillomania.
Note: For some people with trichotillomania, hair-pulling is a way of coping with unpleasant, boredom, loneliness, stress, anxiety, tension, fatigue, and/or frustration or unwanted, uncomfortable, and upsetting emotions. For other people with trichotillomania, pulling at or tugging on their hair provides relief, happiness, relief, or entertainment. These individuals continue to pull out their hair because of the “pleasurable” sensations and emotions associated with doing so.
Is Trichotillomania Common?
Is Trichotillomania Chronic?
Yes, it is.
Trichotillomania is a long-term or chronic anxiety condition. Without proper treatment, symptoms can intensify over time. For instance, the hormonal changes caused by puberty, menstruation, pregnancy, or menopause can aggravate trichotillomania symptoms in some women. And, if left untreated, trichotillomania symptoms may persist, off and on, for weeks, months, years, or forever. Understand, however, that this condition typically persists for longer than a year.
Are There Any Risk Factors I Should Be Aware Of?
Yes, there are!
There are several risk factors you should be cognizant of if you suspect you have trichotillomania or have been diagnosed with it, such as:
- Family History
As mentioned previously, genetics may play a role in the development and progression of trichotillomania, especially if you have a close family member with OCD or an anxiety or mental health condition.
Trichotillomania typically presents shortly before or during the early teenage years (i.e., 10-13 years old. Unfortunately, this condition can persist well into adulthood and last indefinitely. Unbeknownst to many, babies and toddlers can also suffer from trichotillomania, although it is usually temporary and mild. Trichotillomania tends to disappear, without or without, in babies and toddlers.
- Another Mental Health Condition
People, who have trichotillomania, tend to have at least one other mental health condition, like depression, an anxiety condition, or OCD, have an increased risk of developing trichotillomania.
- Chronic Stress
Chronic stress or extremely stressful situations can trigger trichotillomania, in some people.
Note: Although, females are more likely to seek OCD treatment for trichotillomania than males, primarily because females are more likely to seek medical advice – as compared to their male counterparts. However, girls and boys tend to be equally affected by trichotillomania.
How Does Trichotillomania Manifest in Everyday Life?
Trichotillomania is a debilitating and life-altering condition that can manifest in various ways. Recognizing the symptoms of it is crucial for keeping them at bay.
Listed below are common trichotillomania signs and symptoms:
- Continuously pulling at your hair from your scalp, eyebrows, arms, legs, genital areas, eyelashes, etc.
- Escalating stress and tension shortly before pulling out your hair – this stress and tension can also occur if you try to ignore, dismiss, or resist urges to pull or tug at your hair
- Euphoria, happiness, relief, or pleasure while engaged in hair-pulling behaviors and/or after you have pulled your hair
- Significant hair loss – i.e., bald patches, hair loss, thin, sparse, missing, or short hair on various parts of your body, such as on your eyelashes or eyebrows
- Rituals and routines centered on your hair-pulling activities or patterns like pulling out your hair
- Chewing, gnawing on, sucking on, biting, or eating the hair you have pulled out of your body
- Repeatedly playing with or rubbing the pulled-out hair across your cheeks, lips, and/or face
- Excessive grooming can lead to inflamed and/or infected skin
- Constantly trying to stop pulling out your hair, or at minimum attempting to reduce the amount of hair you pull out or how often you do it
- Extreme emotional distress or work or school conflicts that spark hair-pulling behaviors
- Social anxiety that causes you to pull at or tug at your hair in social situations
- Insomnia or sleep issues – Similar to OCD, constant intrusive thoughts, high-stress levels, and anxiety can trigger insomnia or sleep issues in people with trichotillomania.
Note: Keep in mind that some people with trichotillomania also pick at their skin, causing festering sores. Some may also bite, suck or gnaw on, eat, and/or chew on their nails or lips. Some people with the condition also pull the hair from stuffed animals, Barbies, dolls, pets, and even blankets or clothes. People with trichotillomania tend to engage in hair-pulling activities in private so they can “hide” this behavior from other people.
People with this condition may go to extreme lengths to “hide” bald patches, missing eyelashes or eyebrows, etc., from other people by self-isolating. Fortunately, in some cases, trichotillomania may be mild and easily treated. However, in other cases, it can be so severe that it negatively affects their quality of life. The good news is there is a variety of OCD treatment options available to help you better manage your symptoms.
Are People with Trichotillomania Aware of Their Hair-Pulling Behaviors?
Some people with trichotillomania are consciously aware that they are pulling or tugging at their hair. These individuals deliberately pull their hair as a way to ease their stress, angst, emotional distress, and/or tension.
For instance, a person with this condition may intentionally pull out his or her hair as a way to stop the unrelenting urges to pull his or her hair. When a person develops a routine or ritual around their hair, such as pulling hair from a specific area of the body, such as arms, legs, eyebrows, eyelashes, etc. Or, pulling hair at certain times, such as while watching television or when bored. This is referred to as “focused trichotillomania.”
On the flip side, other people may not realize that they are pulling on or tugging at their hair out of boredom, or while reading or watching television. In this case, the person is unaware that he or she is doing it. This is referred to as “automatic or involuntary trichotillomania.”
Note: It is possible for a person to have both “focused trichotillomania” and “automatic or involuntary trichotillomania,” depending on his or her mood. Also, specific actions or rituals or routines (i.e., brushing or styling your hair, putting on a cap or hat, or even putting your hand on top of your head) can “activate” or trigger hair-pulling behaviors.
How Is Trichotillomania Diagnosed?
A thorough evaluation is usually used to diagnose trichotillomania.
This evaluation may include the following:
- Determining how much hair you have lost
- Talking about your hair-pulling behaviors
- Testing to determine if there are other causes for the hair-pulling and hair loss
- Identifying other physical or mental health problems that could be contributing to your hair-pulling behaviors
- Using the diagnostic criteria (from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)) to determine if you have trichotillomania
How is Trichotillomania Treated?
Treatment for trichotillomania is extremely limited, as such, OCD treatments are normally used to treat the condition. The good news is there are various treatments available that can help reduce your OCD symptoms or eliminate them altogether!
Listed below are common OCD treatments for trichotillomania:
Trichotillomania is typically treated using a variety of OCD therapies, such as:
- Habit-Reversal Training
Habit-reversal training is normally the “go-to” treatment for trichotillomania. This technique involves learning how to identify your personal trichotillomania (OCD) triggers – and replace these behaviors associated with other, non-OCD ones, such as going for a walk or job when the urge to pull at, tug on, or pull out your hair. Fortunately, this technique can be added alone or with a prescribed treatment program.
Decoupling is a type of habit-reversal training. This exercise involves deliberately moving your hand from your hair to other parts of your body, such as your stomach, toes, foot, or back.
- Awareness Training
Awareness training can teach you how to determine what is causing the hair-pulling episodes. A psychotherapist may ask you to notate when you feel compelled to pull at or tug on your hair. For instance, what happened shortly before you began to pull out your hair. The amount of time you spent pulling at or tugging on your hair and how it made you feel – while you were doing it and once you stopped doing it.
The key to making this technique work is paying attention to what precipitated the behavior and documenting it in a workbook or journal – i.e., dates, times, mood, places, emotional states, etc. The goal is to identify thought and behavioral patterns. For instance, after reviewing your workbook or journal you may learn that you pull your hair when you get bored or frustrated.
- Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) can help you pinpoint and examine illogical or faulty beliefs that could be triggering your hair-pulling behaviors. The theory is that if you can change your thoughts (thoughts and urges to pull your hair), your behavior (pulling out your hair) will also change.
- Acceptance and Commitment Therapy (ACT)
The goal of acceptance and commitment therapy (ACT) can teach you how to “accept” and “embrace” thoughts and urges to pull your hair – without acting on them.
- Dialectical Behavior Therapy (DBT)
Dialectical behavior therapy (DBT) teaches you how to use mindfulness mediation to combat thoughts and urges to pull at or tug on your hair. The goal of this treatment method is to help you better regulate your emotions, so you do not feel the need to engage in ritualistic behaviors, like pulling out your hair.
- Group Therapy
Group Therapy is designed to help you feel less alone or ashamed of your hair-pulling behaviors. The goal is to provide you with some much-needed support in a therapeutic environment. Group therapists can also provide you with advice, guidance, resources, and self-help tools.
As with most mental health conditions, medications are usually the last resort. For instance, if your trichotillomania (OCD) symptoms have not responded to conventional OCD treatments (treatment-resistant OCD), like CBT, ACT, or other psychotherapies (i.e., individual, couples/marital, family, grief, trauma, etc.), your doctor may prescribe medications, like SSRIs (antidepressants) to help you get a grip on your obsessions and compulsions.
Understand, however, that there are no FDA-approved medications for trichotillomania. However, some antidepressants may be prescribed “off-label” to treat anxiety conditions, like trichotillomania (OCD) symptoms.
Common antidepressants sometimes used to treat trichotillomania include Anafranil, Prozac, Zoloft, Paxil, etc. Other medications that may curb trichotillomania (OCD) symptoms include N-acetylcysteine, an amino acid that is responsible for regulating your mood, and Zyprexa, an atypical antipsychotic medication.
As with all physical and mental health conditions – and one’s overall health and well-being, lifestyle changes may improve your trichotillomania (OCD) symptoms. Researchers have found that a healthy diet and active lifestyle may ease OCD symptoms and improve trichotillomania outcomes.
Studies also suggest that proper sleep may also help curb trichotillomania (OCD) symptoms – in some people. Sleep is important for overall health, but especially for chronic conditions, because it allows your body to heal and revitalize, so you are adequately prepared for the next day – i.e., everyday stress, workplace stress and conflicts, etc.
Natural remedies, like CBD, vitamin, mineral, or herbal supplements, etc., may help reduce or eliminate your trichotillomania (OCD) symptoms. According to researchers, supplements and herbs, like cannabinoids, designed to ease stress and anxiety, may also help “quiet” trichotillomania intrusive thoughts and urges and “quell” compulsive behaviors, like hair-pulling.
Self-help tools, like online OCD treatment programs, can help reduce trichotillomania (OCD) symptoms – in some people. One such program that has shown tremendous success is Impulse Therapy. Impulse Therapy offers a wide range of services, tools (i.e., an OCD assessment), and resources, like an extensive library of OCD content, support and advice (even once you complete the program), CBT, and exercises you can do in the comfort of your home.
Other self-help tools that can help you effectively manage your trichotillomania (OCD) symptoms include mindfulness meditation, minimizing triggers, forming a strong support group, setting up “roadblocks,” hypnosis, and OCD support groups, books, apps, and forums.
What Happens If Trichotillomania Is Left Untreated?
Although trichotillomania may not seem like a serious condition – it is. It can cause devastating consequences for your health and well-being.
These effects may include the following:
- Emotional Distress
Emotional distress is a common trigger for trichotillomania. Many people with this condition report feeling ashamed, humiliated, and embarrassed by their hair-pulling behaviors. People with trichotillomania may also experience low self-esteem and self-confidence, depression, anxiety, excessive worrying, and/or substance abuse as a result of the condition.
- Impaired Social Skills
Bald spots and hair loss (even a loss of eyebrows or eyelashes) can trigger embarrassment and embarrassment can lead to social isolation or avoidance. In other words, it is common for people with trichotillomania to avoid social events, like birthdays or holiday celebrations out of fear of being judged on their appearance. Some people with the condition may even forego job opportunities that require networking activities.
People with trichotillomania tend to “hide” their hair loss by wearing wigs, baseball caps, hats, false eyelashes, eyebrow liner, etc. They may also style their hair in a certain way so that people cannot see their bald spots. In severe cases, people with this condition may avoid dating, romantic relationships, and sex for fear that their condition will be discovered.
- Damaged Skin and Hair
Constantly pulling at or tugging on your hair can damage your skin, scalp, and hair. More specifically, pulling out your hair can cause scarring, and in some cases, infections. Hair-pulling can also permanently inhibit hair growth in those areas.
Hairballs? Yes, if left untreated, trichotillomania can lead to hairballs. More specifically, consuming hair can cause a large, matted hairball, also known as trichobezoar, to form in your digestive tract. After a while, this hairball can lead to significant weight loss, nausea, upset stomach, abdominal pain, constipation, vomiting, intestinal obstruction, and/or death (in severe cases).
- Chattopadhyay, K. (2012). The genetic factors influencing the development of trichotillomania. Journal of Genetics, 91(2), 259–262. Retrieved from https://doi.org/10.1007/s12041-011-0094-6
- King, R. A., Scahill, L., Vitulano, L. A., Schwab-Stone, M., Tercyak, K. P., Jr, & Riddle, M. A. (1995). Childhood trichotillomania: Clinical phenomenology, comorbidity, and family genetics. Journal of the American Academy of Child and Adolescent Psychiatry, 34(11), 1451–1459. Retrieved from https://doi.org/10.1097/00004583-199511000-00011
- American Osteopathic College of Dermatology. (n.d.). Trichotillomania. Retrieved from https://www.aocd.org/general/custom.asp?page=Trichotillomania#:~:text=The%20cause%20of%20trichotillomania%20is%20not%20clearly%20understood,may%20also%20contribute%20to%20this%20impulse%20control%20disorder.
- Chamberlain, S. R., Hampshire, A., Menzies, L. A., et al. (2010). Reduced brain white matter integrity in trichotillomania: A diffusion tensor imaging study. Archives General Psychiatry, 67(9), 965–971. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20819990/
- Grant, J. E., Redden, S. A., Leppink, E. W., & Chamberlain, S. R. (2017). Trichotillomania and co-occurring anxiety. Comparative Psychiatry, 72,1-5. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27668531/
- Grant, J. E., Odlaug, B. L., & Kim, S. W. (2009). N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Archives of General Psychiatry, 66(7), 756–763. Retrieved from https://doi.org/10.1001/archgenpsychiatry.2009.60
- Grant, J. E., Valle, S., & Chamberlain, S. R. (2021). Nutrition in skin picking disorder and trichotillomania. Frontier Psychiatry,12, 761321. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34887788/
- Cavic, E., Valle, S., Chamberlain, S. R., & Grant, J. E. (2021). Sleep quality and its clinical associations in trichotillomania and skin picking disorder. Comprehensive Psychiatry, 105, 152221. Retrieved from https://doi.org/10.1016/j.comppsych.2020.152221
- Grant, J. E., Odlaug, B. L., Chamberlain, S. R., & Kim, S. W. (2011). Dronabinol, a cannabinoid agonist, reduces hair pulling in trichotillomania: A pilot study. Psychopharmacology, 218(3), 493–502. Retrieved from https://doi.org/10.1007/s00213-011-2347-8
- Good Therapy. (n.d.). Getting help for trichotillomania. Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/trichotillomania/get-help
- Keuthen, N. J., Rothbaum, B. O., Fama, J., Altenburger, E., Falkenstein, M. J., Sprich, S. E., Kearns, M., Meunier, S., Jenike, M. A., & Welch, S. S. (2012). DBT-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial. Journal of Behavioral Addictions, 1(3), 106–114. Retrieved from https://doi.org/10.1556/JBA.1.2012.003
- Diefenbach, G. J., Tolin, D. F., Hannan, S., Maltby, N., & Crocetto, J. (2006). Group treatment for trichotillomania: Behavior therapy versus supportive therapy. Behavior Therapy, 37(4), 353–363. Retrieved from https://doi.org/10.1016/j.beth.2006.01.006
- Stein, D. J., Simeon, D., Cohen, L. J., & Hollander, E. (1995). Trichotillomania and obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 56(4), 28–35. Retrieved from https://doi.org/10.1176/ajp.150.7.1131-a
- Mantra Care. (n.d.). Trichotillomania and OCD: How to overcome compulsive hair-pulling and obsessive thoughts? Retrieved from https://mantracare.org/ocd/related-conditions/trichotillomania-ocd/
- Sani, G., Gualtieri, I., Paolini, M., Bonanni, L., Spinazzola, E., Maggiora, M., Pinzone, V., Brugnoli, R., Angeletti, G., Girardi, P., Rapinesi, C., & Kotzalidis, G. D. (2019). Drug treatment of trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and nail-biting (onychophagia). Current Neuropharmacology,17(8), 775-786. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30892151/
- Akaltun, İ. (2019). Trichotillomania is triggered by vitamin D deficiency and resolves dramatically with vitamin D therapy. Clinical Neuropharmacology, 42(1), 20–21. Retrieved from https://doi.org/10.1097/WNF.0000000000000317
- Mayo Clinic. (n.d.). Trichotillomania (hair-pulling disorder). Retrieved from https://www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188