OVERVIEW

What are the specific manifestations of trichotillomania?

Trichotillomania, also known as hair-pulling disorder, is a condition characterized by recurrent urges to pull out one's own or others' hair, eyelashes, beard, nose hair, pubic hair, eyebrows, or other body hair.

When suffering from trichotillomania, patients may experience feelings of "shame" or "self-blame" due to external pressures. At this time, they particularly need support and encouragement from those around them. Please interact with trichotillomania patients without prejudice, respect them, and avoid spreading their privacy.

What are the adverse consequences of trichotillomania?

Trichotillomania typically begins during adolescence. Frustration or stress can trigger the disorder. Patients often develop patchy hair loss or baldness, experience significant anxiety and distress, and suffer from impaired social functioning.

What causes trichotillomania?

The exact cause of trichotillomania remains unclear.

How is trichotillomania treated?

Current research suggests that a combination of cognitive-behavioral therapy and medication is more effective than either treatment alone.

How common is trichotillomania?

There is currently a lack of large-scale epidemiological survey data on trichotillomania in China. Foreign studies indicate that the lifetime prevalence of trichotillomania among college students is approximately 0.6%; in the general population, it affects about 1%–3% of individuals. The condition mostly begins in early adolescence, with the typical onset age being 11–16 years.

SYMPTOMS

Is hair-pulling in trichotillomania always a conscious action?

The main clinical feature of trichotillomania is the repeated pulling out of one's own hair. It often manifests in two forms:

• Unconscious type: Often occurs during contemplation or daily activities. About 3/4 of patients exhibit unconscious hair-pulling behaviors, such as pulling hair unconsciously while watching TV or attending class.

• Conscious type: Hair-pulling is related to the patient's inner impulses, tension, and hair-pulling-related thoughts, often involving tools (e.g., mirrors, tweezers).

Clinically, the two forms often coexist, and very few patients exhibit only one type of hair-pulling behavior.

What are the specific manifestations of trichotillomania patients?

• The most commonly affected areas of hair-pulling are the scalp, eyebrows, and eyelids, while the armpits, face, genital area, and perianal region are relatively less common. Men often pull hair from the abdomen, back, and beard area, whereas women predominantly pull their hair. Some patients may also pull hair from sofas, carpets, stuffed toys, or pets.

• Although the prevalence of trichotillomania shows no gender difference, clinically observed cases may be significantly more common in women than in men. Possible explanations include male patients avoiding treatment, attributing it merely to baldness, or experiencing less stigma associated with hair loss.

• Hair-pulling is often accompanied by changes in emotional state. After hair-pulling, emotions such as tension, anxiety, depression, sadness, anger, embarrassment, frustration, or loneliness may be alleviated. Patients usually experience relaxation and pleasure only during the hair-pulling process.

• After hair-pulling, some patients may experience negative emotions, such as a sense of loss of control or shame.

• The severity and persistence of hair-pulling behavior may frequently fluctuate. When symptoms are mild, they may go unnoticed and cause no significant distress. In severe cases, it can lead to patchy baldness or hair loss.

• If hair-pulling affects appearance, patients may conceal it with wigs, hats, or makeup, and may avoid daily work and social activities, severely impairing psychosocial functioning. Since hair-pulling often occurs at home, disruptions to family life and functioning are also common.

CAUSES

What Causes Trichotillomania?

The exact cause and pathogenesis of trichotillomania are not yet fully understood. Current research suggests it may be related to genetic factors, neurobiological factors (such as abnormalities in the metabolism of central neurotransmitters like 5-HT/dopamine/glutamate and corresponding receptor dysfunction), neuroanatomical abnormalities, psychological and behavioral factors (such as conditioned reflex mechanisms), traumatic experiences, and other aspects.

DIAGNOSIS

How is trichotillomania diagnosed?

A medical diagnosis of trichotillomania requires meeting the following criteria:

• Recurrent pulling out of one's hair resulting in hair loss;

• Repeated attempts to reduce or stop hair pulling;

• Causes significant distress or impairment in social, occupational, or other important areas of functioning;

• The hair pulling must not be attributable to another medical condition (e.g., a dermatological condition) or mental disorder (e.g., attempts to improve perceived flaws in appearance in body dysmorphic disorder).

TREATMENT

Which department should I visit for trichotillomania?

First, go to the endocrinology department to rule out hypothyroidism, calcium deficiency, and other causes. Then, consider visiting the psychiatry or psychology department for further diagnosis. If symptoms are severe and cause folliculitis, a visit to the dermatology department is necessary.

How is trichotillomania treated?

Medication

• The evidence for pharmacological treatment of trichotillomania is still insufficient and controversial. Medications such as SSRIs, olanzapine, topiramate, lamotrigine, N-acetylcysteine, bupropion, and naltrexone may be effective but require further validation.

Behavioral Therapy

• Behavioral theory suggests that the development and maintenance of hair-pulling behavior may occur through conditioned reflex mechanisms, so behavioral therapy can be used to improve symptoms. Habit reversal training has relatively confirmed efficacy and is superior to medication. This method mainly includes four parts:

  • Self-monitoring: Recording hair-pulling behavior;

  • Awareness training: Certain situations can trigger hair-pulling, aiming to increase awareness of these situations and the behavior itself;

  • Stimulus control: Training methods to prevent or interfere with hair-pulling behavior;

  • Competing response training: Training physical behaviors completely different from hair-pulling that can stop its continuation, such as clenching fists.

In addition to the above, methods such as stimulus control, cognitive restructuring, and relaxation training are also included. The combined efficacy of cognitive-behavioral therapy and medication is superior to any single treatment.

DIET & LIFESTYLE

What should people with trichotillomania pay attention to in daily life?

There are no special restrictions in daily life. Just maintain a healthy lifestyle. Do not smoke; exercise regularly and avoid prolonged sitting to prevent overweight and obesity. Exercise 3-5 times a week for about 30 minutes each session, combining aerobic and strength training with moderate intensity and avoiding overexertion. Ensure sufficient sleep every day. Learn to self-regulate when experiencing high stress or emotional tension.

What should people with trichotillomania pay attention to in their diet?

There are no special dietary restrictions. Just maintain a healthy and balanced diet.

• When cooking, use less salt, oil, and high-salt seasonings. Avoid pickled vegetables and meats.

• Do not rely solely on refined grains like white rice and flour. Replace some staple foods with whole grains, legumes, potatoes, or pumpkin.

• Balance meat and vegetables in meals. Prioritize white meats like chicken, duck, and fish, and reduce fatty meat intake. Eggs and milk are important sources of protein and other nutrients.

• Vegetarians can eat more beans and bean products to supplement protein.

• Eat plenty of fruits and vegetables.

• Avoid alcohol as much as possible.

PREVENTION

Can Trichotillomania Be Prevented?

Since the pathogenesis of this disorder is still unclear, there are no specific preventive measures. Maintaining mental health, adjusting mood in a timely manner, and relieving stress in daily life may be helpful.