Trichotillomania, also known as hair-pulling disorder or trich, is classified as a type of obsessive-compulsive disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. The cause is unknown, although it seems to be related to stress or anxiety. There has been a suggestion of a genetic predisposition in developing trichotillomania.

Signs and Symptoms

Trichotillomania is more common in teenagers and young adults. People with trichotillomania describe an increasing sense of tension before hair pulling, or when resisting hair pulling, followed by a sense of pleasure or relief after the hair is pulled. In itself, trichotillomania is not harmful, but it may result in feelings of shame and low self-esteem. Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work life. If significant quantities of the removed hair is also ingested a hairball or bezoar can form, leading to potential intestinal obstruction (also known as Rapunzel Syndrome).


On examination, hair of various lengths can be seen and sometimes they can developing skin irritation caused by the hair pulling.


Trichotillomania can occur in conjunction with a variety of conditions including depression, anxiety disorders, obsessive compulsive disorder (OCD), or attention deficit hyperactivity disorder (ADHD). The two main approaches to treating Trichitillomania are psychological based therapies such as psychotherapy or cognitive-behaviour-therapy (CBT) called habit reversal training or pharmacotherapy (i.e medication). Medication that can be considered effective in some cases are tricyclic antidepressants, n-acetyl cysteine (NAC) and olanzapine (an antipsychotic). NAC tends to be most well-tolerated in terms of side-effects. The charity Trichotillomania Support has information on treatments and self-help advice.