Trichotillomania (hair-pulling disorder)

Diagnosis

To diagnose trichotillomania, you'll likely start by having a physical exam. You may then be referred to a mental health professional with experience in treating trichotillomania. Diagnosing trichotillomania may include:

• Examining your hair loss.
• Checking for possible medical causes of your hair loss. This may include lab tests.
• Talking with you about hair loss, including your behaviors and emotions related to pulling out your hair.
• Identifying any physical or mental health conditions that may occur along with pulling out your hair.

Treatment

Some treatment options have helped many people reduce hair pulling or stop completely. These include therapy and sometimes medicine.

Therapy

Types of therapy that may be helpful for trichotillomania include:

• Habit reversal training. This behavior therapy is the main treatment for trichotillomania. You learn how to recognize situations where you're likely to pull out your hair and how to substitute other behaviors instead. For example, you might clench your fists to help stop the urge. One form of habit reversal training, called decoupling, involves quickly redirecting your hand from your hair to another location when you feel the urge to pull out your hair. Other therapies may be used along with habit reversal training.
• Acceptance and commitment therapy. This therapy can help you learn to accept your hair-pulling urges without acting on them.
• Cognitive therapy. This therapy can help you identify and examine beliefs you have about hair pulling that are not realistic. You can learn healthy ways to think about your condition.

Therapies that help with other mental health conditions that often occur along with trichotillomania, such as depression, anxiety, or problems with alcohol or drug use, can be an important part of treatment.

Medicines

Although no medicines are approved by the U.S. Food and Drug Administration specifically for the treatment of trichotillomania, some medicines may help control certain symptoms, such as anxiety and depression.

For example, your health care provider may recommend an antidepressant, such as clomipramine (Anafranil). Research suggests that N-acetylcysteine (as-uh-tul-SIS-tee-een), an amino acid that affects mood, also may help. Another option that research suggests may have benefit is olanzapine (Zyprexa). This drug is used to treat certain serious mental health conditions that affect the mind.

Talk with your health care provider about any medicine recommended. The possible benefits of medicines should be balanced against possible side effects.

Coping and support

You may find dealing with trichotillomania challenging. It may help to join a support group for people with trichotillomania so that you can meet others with similar experiences who can relate to your feelings and offer support. Having a family member or loved one join you to learn how to respond to your hair pulling also can be helpful.

Ask your health care provider or mental health professional for a suggestion. The TLC Foundation for Body-Focused Repetitive Behaviors is an excellent resource for education, support and treatment options for trichotillomania.

Preparing for your appointment

Seeking help is the first step in treating trichotillomania. At first you may see your primary care provider or a specialist in skin disorders called a dermatologist. Your provider may refer you to a mental health professional with experience in diagnosing and treating trichotillomania.

What you can do

Before your appointment make a list of:

• All your symptoms, even if they seem unrelated to hair pulling. Trichotillomania can cause both physical and mental health symptoms. Note what triggers your urges, how you've tried to deal with them, and what makes the urges better or worse.
• Key personal information, including any major stresses or recent life changes. Include whether anyone else in your family has trichotillomania.
• All medicines, vitamins, herbs or other supplements that you're taking, including the doses and how long you've been taking them.
• Questions to ask to make the most of your appointment time.

Questions to ask include:

• What might have caused me to develop this condition?
• How do you find out if I have this condition?
• Is this something that will go away on its own?
• What treatments do you recommend?
• If I decide to take medicines, how long will it take for my symptoms to improve?
• What are the side effects of the medicines you're recommending?
• What can I do in addition to treatment to improve my symptoms?
• How much improvement can I expect with your treatment plan?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

You'll likely be asked a number of questions, such as:

• When did you first start pulling out your hair?
• Do you pull your hair automatically, on purpose, or both?
• Have you tried to stop pulling out your hair? How did that work?
• Are there times or situations that are likely to trigger hair pulling?
• What feelings do you have before and after you pull out your hair?
• From where on your body do you pull out hair?
• Do you bite, chew or swallow the pulled-out hair?
• How has hair pulling affected your work, school or social life?
• Have you had treatment, such as therapy or medicine, for hair pulling or other emotional issues?

Be ready to answer questions so that you'll have time to talk about what's most important to you.