What is Trichotillomania?

Trichotillomania (TTM and sometimes referred to as trich) is an impulse control disorder characterized by recurrent hair pulling.  The name was created by François Henri Hallopeau in 1889, from the Greek thrix (meaning “hair”), the Greek tíllein (meaning “to pull”), and the Greek mania.   The American Psychiatric Association is on record indicating multiple criteria that must be met in order for a diagnosis of trichotillomania to be made.  The criteria are:

  • An individual’s hair pulling is recurrent.
  • A noticeable pattern of hair loss is observed.
  • The individual affected indicates a feeling of increased tension prior to the hair pulling.
  • The tension is relieved upon pulling hairs.
  • The individual’s hair pulling is not associated with another psychological condition, and there is no medical cause for the hair pulling. Other considerations of medical causes of hair loss include but are not limited to endocrine disorders such as hypothyroidism, infectious diseases such as herpes zoster, skin conditions such as psoriasis, trauma (such as that from radiation), and fungal infections of the scalp.
  • The individual’s hair pulling interferes with or disrupts their social and work activities.

It should be noted that where trich is at issue, an individual’s hair pulling has been occurring repeatedly over time and attempts have been made to decrease or stop hair pulling.  Often, there are ritualistic behaviours associated with individual’s hair pulling.  For instance, the individual may pull at their hair in a certain way and/or search for a particular part of their hair before pulling.  In some cases, the hair pulling may be followed by visual perusal of the hair and/or physical manipulation such as rolling the pulled hair between fingers.

Where trichotillomania is at play, individuals affected will experience hair loss to varying degrees.  Where there is noticeable hair loss, the issue of disguising the hair loss sometimes follows.

How Prevalent is Trichotillomania?

Statistical information about the number of people and related social demographics associated with trichotillomania is sketchy.   Statistics about trichotillomania are generally considered skewed; it is generally agreed by researchers and clinicians that many people affected by the disorder do not seek professional help and are therefore not represented statistically.   With this limitation in mind, when checking out various research channels there seems to be agreement that the number of people affected by trich is in the range of 0.6% to 4% of the overall US population.  The Trichotillomania Learning Center states 2-4% of the population may suffer from chronic hair pulling.  Based on a US population of 300+M, that would put the number of people dealing with trichotillomania in the range of 7 to 10 million.  Studies seem in agreement about:

  • The onset age for trichotillomania being in the 9 to 13 range.
  • Female to male ratio: A 2007 article in the American Journal of Psychiatry reported that females outnumbered males by 3 to 1 among adults. The Diagnostic and Statistical Manual (DSM-5) cited an overall female predominance of 10 to 1.
  • Where an individual’s trichotillomania is not properly diagnosed and treated early, the individual affected may be at greater risk of long-term suffering the effects of trich and less responsive to treatment as time goes by.


Proper diagnosis and related treatment should begin with cognitive behavioral therapy.

Trichotillomania and Hair Replacement

Hair replacement, whether non-surgical or surgical, is secondary to a proper diagnosis and a treatment program that proves effective helping an individual stop hair pulling.  Apart from the source of the disorder being identified and an effective therapeutic course of action in place, any attempts at concealing the effects of trich-related hair pulling (i,e., hair loss) with hair replacement will in all probability be met with continued hair pulling, offsetting the purpose of the hair replacement.

Assuming a diagnosis of trich has been made by a trained clinician and a treatment program is proving effective curbing the hair pulling, hair replacement then becomes a viable course of action.

Trich-induced hair loss, like any hair loss, is highly individualistic. Maybe you’re dealing with a patchy balding area.  Or spot balding in multiple areas.  Or an area marked by thinning strands.  Whatever the extent of your trich-induced hair loss, you’re in recovery mode now and the time is right to move on with hair replacement.  Your options are non-surgical and surgical.  Natural Choice Hair Replacement provides you with a non-surgical option that may include a customized hair system styled to your specification.

Natural Choice Hair Replacement is London and southwestern Ontario’s option for non-surgical hair replacement solutions.  Non-invasive, pain free.  NCHR consults with you.  We’re hands-on, proactive, engaging.  We work with clients.  We order your hair replacement system based on your specifications.  We do the fitting mapped to your natural hairline so your look is natural.  Just as though you still had your original hair.  Cut and styled to perfection, and supported by on-going styling/service support.  Your hair loss replaced by your custom hair-replacement solution.   Your look with hair.  It’s all positive!

Other sources about trichotillomania you may be interested in checking out include: