Trichotillomania (& Eyelashes): Causes & Treatment

Trichotillomania is a rare condition of compulsively pulling out your hair. 

For people with this condition, the impulse feels irresistible and uncontrollable. The recurrent pulling of hair may be from the scalp, eyebrows, eyelashes, or other areas of the body. 

This condition often affects people in adolescence, the teen years, and young adulthood. In the United States, it is estimated that 3 percent of the population experiences trichotillomania at some time in their life. 

The word trichotillomania is a combination of three Greek words:

tricho means hair, tillo means pull, and mania indicates an excessive activity. The condition is often called TTM or trich for short. 

Approximately 20 percent of patients who pull hair eat their hair after pulling, a condition called trichotillophagia.

Symptoms of Trichotillomania

Hair pulling may often be unnoticed, or it can be attributed to other medical conditions. 

If it is severe, it may cause the following:

• Bald patches
• Scarring
• Thin eyelashes
• Eyelashes not growing back

In addition to physical symptoms, trich can be accompanied by feelings of anxiety, isolation, depression, shame, and embarrassment. These symptoms can cause people to self-isolate and avoid social contact.

For many people, this condition happens during times of boredom, anxiety, or stress. According to experts, the symptoms and experience of this condition vary from mild to moderate to severe. These variations may happen in an individual and may be related to times of stress. 

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Causes of Trichotillomania

Several factors can lead to TTM, but the precise cause is still unknown. There are three main areas of research:

Genetic Makeup

There may be a DNA mutation or a specific genetic disposition for this condition. 

Brain Chemistry

There may be certain biochemical changes in the brain that could factor into this behavior. This chemical imbalance could be similar to that found with OCD.

Coping With Stress

Many people with TTM report starting to have this condition after a stressful period in their life. Others describe that the behavior began out of boredom and developed into a repeated habit.

Risk Factors

TTM is more common in young children, infants, and teens. For young children, it often starts and goes away on its own. For children, it occurs about equally in males and females. 

The more serious form of TTM typically starts around ages 10 to 13. It is more prevalent in adult women, who show this condition nine times more than men. 

It is estimated that this is a relatively rare condition, affecting 0.5 to 3.4 percent of adults.

Effects of Eyelash Plucking

According to the American Academy of Ophthalmology, repeatedly pulling out eyelashes can make lashes grow slower. Over time, they may not grow back. 

Additionally, there is a greater risk of eye injury, eye infection, and damage to the eyelid skin if eyelashes are pulled out.

Trichotillomania often affects mood, self-esteem, and self-confidence. People often feel embarrassed about the impact of this behavior. 

They may avoid social contact, isolate themselves, and not want to be seen in public. Shame may also inhibit people from speaking about this condition and seeking treatment.

Diagnosis of Hair-Pulling Disorder

If you or someone you know suffers from compulsive hair pulling, a diagnosis can be the first step to finding help. 

If you are a teenager, consider talking with a school counselor, parent, or teacher. They can help you understand what to expect when talking with a doctor or therapist.

Your health care provider may take a skin sample and send it to a lab for analysis. This will help rule out other skin conditions that might be the root cause. This diagnostic test is often called a punch biopsy. 

In some cases, in addition to pulling hair, individuals swallow their hair. If your health care provider is looking for this, they may recommend additional tests. These could include a CT scan and blood testing.

Your health care provider may also refer you to a dermatologist who can help with treating skin conditions or damage. Skin grafting may be recommended for affected areas of the body. A plastic surgeon or reconstructive surgeon may be able to help with this as well.  

Treatment for Trichotillomania

Treatment for hair-pulling is often a combined approach of medication and cognitive behavioral therapy.

Medication

Medication alone is often not enough, and it is generally best used in combination with therapeutic methods.

There are four types of medications that can be used to treat trichotillomania:

• Antidepressants: These may be useful to reduce depression, which is associated with trichotillomania, and to even out moods. 
• Antipsychotics: These can help balance brain chemistry if another diagnosis is present with trich. 
• Anticonvulsants: These may help with TTM since OCD is often also present.
• Nutraceuticals: Nutrition products, such as amino acid supplements, are sometimes used to address trich.

CBT

CBT is a form of therapy that can be effective in treating trichotillomania. Cognitive behavioral therapy uses awareness of thought patterns and habits to initiate change. 

Habit reversal therapy is one form of CBT that is often used to treat trich. By working individually with a therapist, individuals can become more aware of activities and behaviors like hair-pulling. 

Habit reversal therapy has shown the best success in treating TTM.

Group Support

People who have TTM may benefit from group therapy and peer support. Patients who have recovered from trich say that talking with other people with this condition was helpful in their long-term recovery.

When to See a Doctor

Trichotillomania is a challenging condition that is difficult to diagnose and treat on your own. 

If you or someone you know is suffering from trich, it is helpful to talk with someone you trust. This may be a parent, counselor, or health care provider. 

Ultimately, a doctor or health care provider can diagnose, evaluate, and treat this condition. They can help you understand the root causes of your condition. With professional help, you can effectively manage this condition.

Trichotillomania FAQs

Do eyelashes grow back after trichotillomania?

Even if you’ve been pulling out your eyelashes due to trichotillomania, your lashes will grow back. They often grow in thinner than before, but with care and time, they can become long and thick again. 

How can eyelashes grow back faster after pulling them out?

Talk with your doctor about options such as Latisse to increase the length and thickness of lashes. They can help you understand what to expect with the use of growth-promoting eyelash treatments.

How to stop pulling out eyelashes due to trichotillomania?

Cognitive behavioral therapy (CBT) is one of the best ways to understand hair-pulling behavior through therapy and self-monitoring. Working with a licensed professional, patients often keep a journal to track behavior, moods, urges, and adaptive behaviors. 

What therapies help with pulling out your hair?

When you work individually with a therapist, you’ll have a safe space to understand what is going on, learn new behavioral strategies, and track progress. Participating in group therapy may offer an additional form of social support to stop pulling out your eyelashes.

Some therapies offer suggestions known as replacement habits. These may be activities like squeezing a ball, drawing a picture, or touching textured fabrics. Working with a therapist, you can learn how to replace the hair-pulling habit with a new habit that is not hurtful. 

Over time, experts say the urge to pull hair becomes weaker, and it is easier to select the new healthy habit.

Is trichotillomania an anxiety disorder?

Trichotillomania is an impulse control disorder, but it is often related to anxiety. It is also commonly linked with obsessive-compulsive disorder.

What are the symptoms of trichotillomania?Symptoms of trichotillomania include repetitively pulling out your hair, such as your eyelashes, and experiencing a sense of relief when you do so. You may also experience stress and anxiety related to your hair-pulling and be unable to stop the behavior.

References

1. Trichotillomania Hair-Pulling Disorder and Eyelashes. American Academy of Ophthalmology.

    

2. Trichotillomania. (1999). American Academy of Optometry.

3. Trichotillomania. Cleveland Clinic.

4. Trichotillomania. (September 2016). American Journal of Psychiatry.

5. Update on Trichotillomania. (May 2012). Psychiatric Times.

6. Trichotillomania (Hair Pulling Disorder). National Health Service.

7. Overview – Obsessive Compulsive Disorder (OCD). National Health Service.

8. Trichotillomania Comorbidity in a Sample Enriched for Familial Obsessive-Compulsive Disorder. (October 2019). Comprehensive Psychiatry.

9. Trichotillomania (for Teens). Nemours KidsHealth.

10. Going to a Therapist (for Teens). Nemours KidsHealth.

11. Overview – Cognitive Behavioral Therapy (CBT). National Health Service.

12. Skin Biopsy. Cleveland Clinic.

13. Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials. (April 2019). Frontiers in Behavioral Neuroscience.

14. Four Things Not to Say to a Person With Trichotillomania. Anxiety and Depression Association of America.

15. Management of Trichotillomania with Bimatoprost. (2010). American Academy of Optometry.

16. A Thriving Practice Built on a Rare Specialty. (April 2003). American Psychological Association.

17. Trichotillomania. John Hopkins Medicine.