What Is Trichotillomania?
Trichotillomania is an impulse-control disorder characterised by the repeated pulling out of one's own hair and difficulty stopping this behaviour. The term — derived from the Greek words "trich" (hair), "tillein" (to pull), and "mania" (madness) — was first described in 1889 by French dermatologist François Henri Hallopeau. As of 2026, trichotillomania affects approximately 1–2% of the world's population and is four times more common in women than in men.
Causes of Trichotillomania
Although the exact cause of trichotillomania has not yet been fully established, several factors are thought to act in combination:
- Genetic predisposition: Individuals with a family history of obsessive-compulsive disorder or similar impulse-control problems are at higher risk of developing trichotillomania.
- Neurochemical imbalance: Dysregulation of neurotransmitters such as serotonin and dopamine can weaken impulse-control mechanisms.
- Stress and anxiety: Hair-pulling behaviour is frequently triggered or intensified during periods of intense stress. Many patients report that pulling provides temporary relief.
- Emotional trauma: Childhood trauma, experiences of loss, or chronic emotional pressure can act as triggers at the onset of trichotillomania.
Symptoms and Clinical Presentation
Trichotillomania manifests in various ways:
- Irregularly shaped bald patches of varying sizes on the scalp
- A rough texture on the scalp due to broken hairs of different lengths
- Pulling behaviour also affecting the eyebrows, eyelashes, and other hair-bearing areas of the body
- Increased tension before pulling and a temporary sense of relief afterwards
- Attempts to conceal the behaviour: wearing hats, headscarves, or using makeup
Trichotillomania typically begins between the ages of 10 and 13, though it can emerge at any age. If left untreated, it may become chronic and lead to significant social isolation.
Risk of Permanent Damage to Hair Follicles
The most serious physical consequence of trichotillomania is the damage that repeated pulling inflicts on the hair follicles. In the early stages, follicles can regenerate and hair can regrow. However, years of chronic pulling can cause the formation of permanent scar tissue in the follicles — a condition known as cicatricial alopecia. When this occurs, the follicles are completely destroyed and natural hair regrowth is no longer possible.
Current Treatment Approaches in 2026
Treatment of trichotillomania requires a multidisciplinary approach:
- Cognitive behavioural therapy (CBT): Regarded as the most effective psychotherapy method. Habit reversal training helps patients become aware of the urge to pull and develop alternative behaviours.
- Pharmacotherapy: Selective serotonin reuptake inhibitors (SSRIs), N-acetylcysteine, and low-dose antipsychotics may provide benefit in some patients.
- PRP treatment: Platelet-rich plasma therapy can support the regeneration of follicles that have been damaged but not yet completely destroyed.
- Hair transplantation: In patients who have achieved long-term remission and have sustained permanent follicle damage, hair transplantation using the FUE method may be performed. However, carrying out a hair transplant without first addressing the underlying psychological condition carries the risk of the newly transplanted hair also being pulled out. For pricing, please contact us for a personalised consultation.
A Holistic Approach at Virtuana Clinic
At Virtuana Clinic, we offer a comprehensive treatment plan for our trichotillomania patients. We first ensure that the patient's psychological treatment has been initiated or completed. We then carry out a detailed assessment of the scalp to determine the extent of follicle damage. Options such as PRP, mesotherapy, and hair transplantation where necessary are planned on a personalised basis. Our goal is to support both the psychological well-being and the aesthetic satisfaction of our patients.
This article is for informational purposes only. Please consult a qualified physician for treatment decisions.