Trichotillomania (compulsive hair pulling)

Trichotillomania means repeatedly pulling out your own hair, from the scalp, eyebrows or eyelashes, often unconsciously and linked to stress, anxiety or boredom. It is considered a body-focused repetitive behaviour (BFRB) and is more common than many people think. It is nothing to be ashamed of, and help is available.

On the scalp it often shows as uneven areas where the strands are of different lengths or broken, and bald patches of irregular shape, unlike the smooth, round patches of alopecia areata. It is often precisely that uneven, "chewed" edge that distinguishes trichotillomania from other types of hair loss.

The most important thing to know is that the treatment is primarily not about the hair, but about the behaviour. With the right support, often cognitive behavioural therapy (CBT) and a method called habit reversal, the pulling can be broken. And the good news is that in most cases the follicles are not permanently damaged with moderate pulling; when the pulling stops, the hair usually grows back on its own.

With very long-term pulling, however, the follicles can be permanently damaged, much like in traction alopecia. Only then, and only once the behaviour has stopped, can a hair transplant become relevant. Transplanting while the pulling is ongoing does not work. If you suspect trichotillomania in yourself or someone close to you, we primarily recommend speaking to a doctor or psychologist. You are warmly welcome to us for a no-obligation assessment, and we meet you without judgement.