Thursday, June 19, 2014


Some people have a penchant for nervously or distractedly playing with their hair, constantly touching it or twisting it in their fingers. And some folks take this habit a step further, to the point where it becomes a real problem.

Trichotillomania is a medical condition where sufferers compulsively pluck out their hair. The name comes from the Greek words: trich (hair), till (en) (to pull) and mania (an abnormal love for a specific object, place, or action). This behavior often leads to hair thinning and even bald patches. Frequently, repetitive rituals are performed on the hairs after they have been pulled out. These rituals can include biting on the hair, twisting it, chewing it, playing with it or even swallowing it. Plucking hair out and then eating it is known as trichophagia; over time, this condition can lead to the formation of large trichobezoars (dark stinking masses composed of matted hair and food residue) in the stomach and small intestine. If untreated, such a bezoar can block the digestive tract, requiring emergency surgery.

While far more women and adolescent girls seek treatment for their trichotillomania, survey studies suggest chronic hair pulling also occurs in males. Diagnosis may be complicated by patient and family denial or ignorance of the hair pulling. Accurate scalp examination and scalp biopsies may be needed to obtain a definite diagnosis. Treatment is difficult: the tricyclic antidepressant clomipramine is the most promising agent, but many patients find it difficult to tolerate at adequate dosages, and treatment response may not be maintained over the long term. More benign medications have not demonstrated efficacy in controlled studies. Specialized psychotherapy, known as habit reversal training, is highly recommended; however, skilled therapists can prove difficult to find.

 Hair loss caused by trichotillomania in a 24-year-old woman. (Image from: Varyani et al. 2012)

An article published in the International Journal of Trichology in 2013 describes the case of a 9-year-old Hindu girl from a middle-class family who compulsively pulled out her hair and swallowed it. This behavior persisted for two years. She was treated by a pediatrician and dermatologist for alopecia areata because the mother did not wish to disclose the true nature of the problem, fearing the stigma attached to mental illness. Finally, the girl developed severe abdominal pain and a large trichobezoar had to be surgically removed from her digestive tract. After recovering, she was referred to a psychiatric department and diagnosed with trichotillomania. A treatment regime consisting of medications and psychotherapy was initiated, and the condition gradually resolved. 1 year later, the child was still symptom-free.

Hair loss caused by trichotillomania in a 9-year-old Hindu girl. (Image from: Sachdeva 2013)

Weirdly enough, a similar condition to trichotillomania also occurs in domestic cats. Cats groom themselves by licking their fur, and when stressed or bored (e.g. forced to stay alone in a small apartment all day), they can obsessively over-groom to the point where a part of their body - often the forepaws or belly - becomes completely bald. Also, cats develop trichobezoars - colloquially known as "hairballs". Hairballs, which look rather like baby dreadlocks, can cause periodic vomiting, which is quite a nuisance for the cat's owner. Some cat foods are specially formulated to help the cat naturally pass the ingested hair with stool; malt paste and giving the cat access to fresh grass are good preventive measures too. (Yes, you've guessed it, I own a cat!)


Walsh KH, McDougle CJ. (2001) Trichotillomania. Presentation, etiology, diagnosis and therapy. Am J Clin Dermatol. 2(5):327-33.

Varyani N, Garg S, Gupta G, Singh S, Tripathi K. (2012) Trichotillomania and dermatitis artefacta: A rare coexistence. Case Rep Psychiatry. 2012: 674136.Published online Feb 9, 2012. 

Sachdeva A. (2013) Managing a case of trichotillomania with trichobezoar. Int J Trichology. 5(4): 228–230.

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