Pulling Your Hair Out – Complexities of Trichotillomania

Many of us have felt overwhelming anxiety or worry that has made us want to “pull our hair out.” There is a real psychological disorder where sufferers actually yank out their hair as a result of unwanted emotions or feelings called trichotillomania. Individuals have an irresistible urge to pull out hair from his or her own body or occasionally from the body of others.

Trichotillomania is seen to have a neurobiological basis. Because it is triggered by a variety of stressful or traumatic life events, simple one-fit-all treatment modalities such as use of anti-depressant medications (e.g. SSRIs) will not completely cure the trichotillomania. There is no magic pill or quick fix for trichotillomania management. It is a complex disorder and requires equally complex therapy.

HairA recent study published in Behaviour Research and Therapy examined possible phenomenological differences between the automatic and focused styles of pulling in youths with trichotillomania. It looked at differences in severity, phenomenology, co-morbid psychiatric symptoms, and functional impact in individuals with varying levels of hair pulling styles. Youths between the ages of 10 and 17 years were asked to participate in the study via an Internet-based survey. 186 individuals with chronic hair pulling behavior were classified as “high-focused” or “low-focused” and either “high-automatic” or “low-automatic” when pulling out their hair. These classifications were based upon scores obtained on the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C).

Results demonstrated large differences in pulling styles. “High-focused” pullers reported more severe trichotillomania and greater symptoms of anxiety and depression than “low-focused” pullers, and “high-automatic” pullers reported greater symptoms of depression than “low-automatic” pullers.

This study is the first of its kind to highlight the different trichotillomania presentations and the wide range of symptom severity. Health professionals need to be aware of the constellation of possible symptoms, and treat trichotillomania on a case-by-case basis, using a extensive assortment of treatment options.


C FLESSNER (2008). Styles of pulling in youths with trichotillomania: Exploring differences in symptom severity, phenomenology, and comorbid psychiatric symptoms? Behaviour Research and Therapy, 46 (9), 1055-1061 DOI: 10.1016/j.brat.2008.06.006

Sabrina Behrens, MA

Sabrina Behrens, MA, is a freelance writer and psychotherapist. She holds a BA in English from UCLA and a MA in clinical psychology from Pepperdine University. She spends her free time reading, writing, baking and spending time with her family.
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