Trichotillomania (Hair Pulling)

Trichotillomania, or hair-pulling disorder, is a mental health condition in which a person repeatedly pulls out their own hair from the scalp, eyebrows, eyelashes or elsewhere and finds it very hard to stop. It belongs to the obsessive-compulsive and related disorders and is classed as a body-focused repetitive behaviour. It affects roughly 1 to 2 in 100 people, often starting around puberty.

It is not a habit that willpower alone will fix and it is not self-harm in the usual sense. The treatment that works is psychological. The hair usually regrows once pulling stops, although years of pulling can permanently damage follicles.

Symptome

• Repeated pulling resulting in patchy hair loss, often on the crown or the side of the dominant hand
• Broken hairs of different lengths within irregular patches
• Missing or sparse eyelashes and eyebrows
• Rising tension before pulling or when resisting, and relief or gratification afterwards
• Pulling without awareness while reading, studying, driving or watching a screen
• Rituals such as examining, rolling, biting or swallowing the hair
• Shame, concealment with hats, scarves or make-up, and avoiding hairdressers, swimming or intimacy
• Repeated attempts to stop or cut down

Ursachen und Risikofaktoren

No single cause is known. It runs in families, which suggests a genetic contribution, and brain imaging points to differences in the circuits that govern habit formation and impulse control. Pulling commonly serves to regulate emotion: it may soothe stress, anxiety or boredom, or satisfy an urge set off by a hair that feels coarse or out of place. It often coexists with anxiety, depression, skin picking, nail biting, OCD or ADHD. It is not a sign of poor parenting or weak character.

Wie es diagnostiziert wird

• Clinical interview: A psychiatrist or clinical psychologist confirms the pattern of pulling, the attempts to stop, and the distress or impairment, and screens for related conditions.
• Dermatology examination with trichoscopy: Shows broken hairs of varying length, coiled and flame-shaped hairs and black dots, which helps to separate it from alopecia areata and fungal infection.
• Scalp biopsy: Occasionally used when the diagnosis is uncertain or pulling is denied.
• Assessment for swallowed hair: Abdominal pain, vomiting or weight loss in someone who eats the hair needs imaging to look for a hairball.

Behandlungsmöglichkeiten

• Habit reversal training: The best-supported treatment, a form of CBT. It combines awareness training, identifying triggers, and a competing response such as clenching the fists when the urge rises.
• Comprehensive behavioural (ComB) and acceptance-based therapy: Extends habit reversal by tackling the sensory, emotional and situational triggers, and by teaching tolerance of urges through acceptance and commitment approaches.
• Stimulus control: Practical barriers: gloves or finger plasters, fidget tools, short hair, covering mirrors, changing high-risk routines.
• Medication: No medicine is approved specifically. N-acetylcysteine has shown benefit in one adult trial but not clearly in children. SSRIs mostly help accompanying anxiety or depression more than the pulling itself. A psychiatrist decides.
• Family-based support for children: Parents learn to reward effort, not to punish or police pulling.
• Dermatological care: Treating scalp irritation, and using minoxidil where appropriate to support regrowth once pulling has reduced.
• Hair transplant or eyebrow transplant: Considered only for permanent scarring loss, and only after pulling has been in sustained remission, generally for at least a year and ideally confirmed by the treating therapist. Transplanted hair can be pulled out just like any other hair.

Wenn es dringend ist

Seek local medical care promptly for abdominal pain, vomiting, feeling full quickly or unexplained weight loss in someone who swallows hair, as a hairball can block the bowel. Thoughts of suicide or severe depression need same-day help from local emergency or crisis services. None of these are situations for travel.

Reisen nach Türkiye zur Behandlung

This is not a condition to travel for. Effective therapy involves weekly sessions over several months, in your own language, with booster sessions later; many therapists offer it online. A visit can sensibly offer a dermatological assessment to confirm that follicles are intact, or, for someone in long remission with permanent patches, a surgical opinion on scalp or eyebrow restoration. A responsible surgeon will decline to operate while pulling is ongoing.

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