TRICHOTILLOMANIA – Causes, Symptoms & Diagnosis


Trichotillomania is characterized by an impulsive urge to repeatedly pull out one’s own hair, resulting in noticeable patches of baldness. The hair on the scalp is most often affected.

The eyelashes, eyebrows, and beard can also be affected. In some cases, affected individuals chew and/or swallow (ingest) the hair they have pulled out (trichophagy), which can result in gastrointestinal problems. Trichotillomania causes emotional stress and often impairs social functioning.

Signs & Symptoms
Individuals with trichotillomania repeatedly experience a violent urge to pull out their hair. There is always a sense of satisfaction immediately after pulling which gets replaced with depression after some time. Patient always wants to stay in solitude. The severity and the specific areas of hair on the body that are affected can vary greatly from one individual to another. The scalp is the most commonly affected area in trichotillomania. Affected individuals may break off pieces of hair or pull out entire strands. In most cases, individuals pull out hair from one or more areas. Although the scalp is the most common site involved, the beard, eyelashes, and eyebrows may also be involved. Less commonly, individuals may also pull hair from the armpits, trunk, and/or pubic areas. There may be a generalized tingling or itching (pruritus) in the involved areas, but affected individuals usually do not typically experience pain after hair plucking, once the habit is established. Irritation may occur at affected sites.

Other symptoms
• Feeling tense before pulling hair or when trying to resist the urge to pull hair
• Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
• Distress or problems in work or social life due to hair pulling
• Patches are seen where the hair has been pulled out.
• Behaviours such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair.

Some affected individuals may chew or swallow (ingest) their hair, a condition known as trichophagy. In rare cases, ingestion of hair may lead the formation of a hairball in the stomach (trichobezoar) resulting in abdominal pain, nausea and vomiting, anemia and/or bowel obstruction. Affected individuals are often extremely secretive about the behaviour and may avoid social situations. Trichotillomania can occur in conjunction with mood and anxiety disorders such as depression, obsessive compulsive disorder or attention deficit hyperactivity disorder

The exact cause of trichotillomania is not known and poorly understood. Most likely, trichotillomania results from several factors occurring together including genetic, environmental factors and stress.
It is the way to exhibit anger, depression .Patient under these impulses start pulling it without being noticing it .It normally happens while watching television, reading books, during exam, inside the washroom, during sleep
Some cases of trichotillomania have been associated with previous traumatic events.

A diagnosis of trichotillomania may be suspected if characteristic symptoms are present such as noticeable patches of hair loss. A diagnosis may be made based upon a thorough clinical evaluation, a detailed patient history as many individuals attempt to conceal their hair pulling behaviour, making diagnosis difficult. Capilloscopy reveals short broken hair which are called as stubs. There are boils, redness in that area. Itching is prevalent.