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Clinical diagnosis of trichotillomania takes place in consultation with a doctor, clinical psychologist or psychiatrist. If you visit your doctor (GP) for a diagnosis, as well as relying on what you say, the doctor must clearly rule out any other form of hair loss. A referral to a dermatologist must be made.
Classed as a mental health condition, trichotillomania is often grouped with other conditions like attention deficit, tics, obsessive compulsive disorder (OCD) and BFRBs (body focused repetitive behaviours).
As the expression “tearing your hair out” implies, sifting through and even pulling individual strands of hair is a natural response to stress. If the hair pulling action recurs and does not go away, you can safely say that you have trichotillomania. More often than not, this condition occurs in highly sensitive individuals.
Trichotillomania, or compulsive hair pulling, often starts with searching for split-ends or searching for hairs which feel different and encompasses hair-twirling. For many, this is a textural phenomenon. People with trichotillomania often get great satisfaction from rubbing hair on their face or lips, as well as hair stroking and pulling hair out.
The American DSM-V manual states that diagnosis of trichotillomania must include recurrent pulling out one’s hair, resulting in hair loss which is not from another medical or dermatological condition; repeated attempts to decrease or stop hair pulling; significant distress or impairment in important areas of functioning.
Classed as a mental health condition, trichotillomania is often grouped with other conditions like attention deficit, tics, obsessive compulsive disorder (OCD) and BFRBs (body focused repetitive behaviours).
Trichotillomania, or compulsive hair pulling, often starts with searching for split-ends or searching for hairs which feel different. For many, this is a textural phenomena. People with trichotillomania often get great satisfaction from rubbing hair on their face or lips, as well as stroking and pulling their hair out.
The American DSM-V manual states that diagnosis of trichotillomania must include recurrent pulling out one’s hair, resulting in hair loss which is not from another medical or dermatological condition; repeated attempts to decrease or stop hair pulling; significant distress or impairment in important areas of functioning.
The DSM is a worldwide accepted diagnostic template for (what are classed as) mental illnesses. The goalposts of such documents move as directed by economics as well as by science. Using worldwide templates such as these, does not take into account environmental influences, the emotional world and history of the hair-pulling individual. It is wrong to state that everybody who compulsively pulls out their hair is mentally ill. The DSM is a starting point for clinicians. People are unique and many people pull their hair out and have no other signs of anxiety. Professionals need to place more emphasis on listening, and less on standardised diagnosis.
Most people with tric do not have visible bald patches and would not “stick out” in a crowd. Statistically, there is one person with trichotillomania in every class of 50 people. Many people pick at their skin and twirl or pull on their hair in the normal course of life. For some, hair pulling is an unconscious or subconscious condition while for others there is an urge to pull. Most people with tric can relate to both types of pulling.
In common with OCD, hair-pullers have a high tendency to ruminate. Our experience with British people with trichotillomania has been that social distress often precedes and is a related cause of pulling, while those who have presented for our trichotillomania treatment in the USA often show fewer problems with social interaction.
Updated 12 May 2023, review 12 May 2024
