Although it affects a small proportion of the population, trichotillomania is a relatively well-known disease. A quick Google search comes up with dozens of personal essays, support groups, and YouTube videos devoted to discussing compulsive hair-pulling. That being said, the signs of trichotillomania go beyond what most people understand about it; like many psychological disorders, there's more at play than the easily-recognized symptoms — in this case, hair-pulling. The irresistible urge to pull out your hair is the defining characteristic of trichotillomania, but there are a number of other behaviors needed to take it into disordered territory.
Trichotillomania is one of several disorders on the obsessive-compulsive spectrum, which share some similarities with obsessive-compulsive disorder (OCD). Like OCD, trichotillomania is characterized by compulsions — specifically, the irresistible impulse to pull out hair. People usually focus on the scalp, but it's not uncommon to pull at eyebrows, eyelashes, or even pubic hair. In order to be considered trichotillomania, the Diagnositic Statistical Manual (DSM) 5 notes that the hair-pulling has to be so extensive that it causes hair loss, usually in the form of bald patches.
For some people, the action might be so automatic they don't realize they're doing it, while others may have specific rituals surrounding the hair-pulling. The disorder's specifics are different for everyone, but there are a number of signs to look out for. Let's examine a few below.
1. You Find Relief From Pulling Out Hair
A central aspect of trichotillomania is the relief that comes from pulling out hair; this is sometimes preceded by a feeling of tension that can only be released by the behavior, especially if you're resisting the urge. (If you're familiar with OCD, you no doubt recognize this is pretty much the definition of defintion of a compulsion, although the tension felt with trichotillomania isn't necessarily anxiety.)
2. The Urge To Pick Is Uncontrollable
People with trichotillomania may try to resist the urge, but one of the criteria for the disorder is its uncontrollable nature — you might try to stop, but you can't without help.
3. You Develop Bald Spots
As discussed above, the hair-pulling has to be so intense that it causes thinning or loss of hair entirely in the affected areas.
4. You Try To Hide It
Trichotillomania involves a sense of shame surrounding the hair-pulling, which causes many people to go to great lengths try to hide signs of the disorder, especially if bald spots start to form. However, the actions may become so automatic that some people with trichotillomania don't even realize they're pulling hair out.
5. It's Long-Lasting
Trichotillomania is a chronic disorder that often, but not always, starts in childhood and continues to adulthood. Although it may improve or worsen throughout your life, trichotillomania is typically a chronic condition.
6. It Worsens With Stress
Researchers have noted many similarities between trichotillomanio and OCD — namely, the ritualistic nature of the actions and the feeling of relief upon performing them. Like those with OCD, the International OCD Foundation writes that people with trichotillomania may find their symptoms worsening during times of change, whether negative or positive.
7. It's Not Self-Harm
It's easy to assume that hair-pulling stems from a desire to self-harm, but people with trichotillomania aren't usually trying to hurt themselves any more than someone who bites their nails. As the Trichotillomania Learning Center points out, the disorder resembles tics or rituals more than self-harm.