Trichotillomania
Open accessAbstract
Trichotillomania, characterized by the repetitive pulling out of one’s own hair leading to hair loss and functional impairment, has been documented in the medical literature since the 19(th) century, but has received scant research attention. Community prevalence studies suggest that trichotillomania is a common disorder with point prevalence estimate of 0.5% to 2.0%. Although recently grouped with OCD in the DSM-5, clinicians need to be aware that trichotillomania and OCD may have less in common than originally thought. In fact, approaches to treating trichotillomania, which include habit reversal therapy and medication (n-acetyl cysteine or olanzapine), are quite different from those used to treat OCD; and some first-line treatments used for OCD appear ineffective for trichotillomania. Based on our clinical experience and research findings, the article recommends several management approaches to trichotillomania.
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The most common sites pulled in trichotillomania include the scalp, eyebrows, and eyelashes, although pulling from other areas of the body is common.
“The most common sites pulled include the scalp, eyebrows, and eyelashes; although, pulling from other areas of the body is common.[11]”
From Trichotillomania (hair pulling disorder) (2019) · cites this paper as [11]
The Clinical Description identifies the scalp (72.8%) and eyebrows (56.4%) as the two most common sites and says pulling can occur at any bodily region with hair. It names the pubic region (50.7%), not the eyelashes, as the next most common site, so the full list in the claim is not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPulling from multiple sites is not uncommon and pulling episodes can last from a few minutes to several hours.
“Pulling from multiple sites is not uncommon and pulling episodes can last from a few minutes to several hours.[11]”
From Trichotillomania (hair pulling disorder) (2019) · cites this paper as [11]
The Clinical Description (page unavailable) reports substantial percentages of patients pulling from the scalp, eyebrows, and pubic region, consistent with pulling from multiple sites being not uncommon. The Case Vignette (page unavailable) describes one patient pulling for one to two hours each day and, after treatment, for 5–10 minutes every several days. It does not establish that individual pulling episodes generally range from a few minutes to several hours. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe onset of hair pulling is generally in late childhood or early adolescence.
“The onset of hair pulling is generally in late childhood or early adolescence.[11]”
From Trichotillomania (hair pulling disorder) (2019) · cites this paper as [11]
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Self-citationHair‐pulling disorder (Trichotillomania): Etiopathogenesis, diagnosis and treatment in a nutshell
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Cortical thickness abnormalities in trichotillomania: international multi-site analysis
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Self-citationAutomatic and Focused Hair Pulling in Trichotillomania: Valid and Useful Subtypes?
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Self-citationSleep quality and its clinical associations in trichotillomania and skin picking disorder
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Self-citationNonpharmacological treatment approach in trichotillomania (hair-pulling disorder)
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Body-focused repetitive behaviors
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Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling
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An Update on Alopecia and its Association With Thyroid Autoimmune Diseases
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Clinical Presentation of Body-Focused Repetitive Behaviors in Minority Ethnic Groups
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Self-citationBezerra, A. P., Machado, M., Maes, M., Marazziti, D., Nunes-Neto, P. R., Solmi, M., Firth, J., Husain, M. I., Brunoni, A., Kurdyak, P., et al. (2020) · CNS Spectrums · doi:10.1017/s109285292000111x · Cited by 11 · see citing works
Placebo Response in Trichotillomania
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A Pilot Examination of Oxidative Stress in Trichotillomania
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Self-citationAddressing body-focused repetitive behaviors in the dermatology practice
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Understanding the Association Between Mental Health and Hair Loss
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Massachusetts General Hospital Hairpulling Scale: Validity and Reliability Study of the Turkish Form
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Novel inflammatory targets for immunotherapies in pediatric patients with trichotillomania
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Quality of Life in Trichotillomania: An Assessment of Specific Life Domains
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Self-citationAn fMRI Pilot Study of Cognitive Flexibility in Trichotillomania
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Self-citationSalivary sex hormones in adolescent females with trichotillomania
Grant, J. E., & Chamberlain, S. R. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.05.012 · Cited by 9 · see citing works
Self-citationGastric Trichobezoars in paediatric population– A series of six cases and literature review
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Alopecia and techniques in hair restoration: an overview for the cosmetic surgeon
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Trichotillomania associated with a 25-hydroxy vitamin D deficiency: A case report
Titus-Lay, E. N., Eid, T., Kreys, T.-J., Chu, B. X. J., & Malhotra, A. (2020) · Mental Health Clinician · doi:10.9740/mhc.2020.01.038 · Cited by 7 · see citing works
The genetics of trichotillomania and excoriation disorder: A systematic review
Reid, M., Lin, A., Farhat, L. C., Fernandez, T. V., & Olfson, E. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152506 · Cited by 11 · see citing works
Zhou, H., Zhang, Y.-X., Lei, Q.-K., Li, Y., & Zheng, Y. (2025) · Stem Cell Research & Therapy · doi:10.1186/s13287-025-04447-7 · Cited by 8 · see citing works
White matter volume alterations in hair-pulling disorder (trichotillomania)
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Latent class analysis of emotions experienced during compulsive hair-pulling episodes.
Hicks, M. M., Mouton-Odum, S., Patyk, K. C., Zamora, R. J., & Nadai, A. D. D. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101882 · Cited by 9 · see citing works
Head and neck dermatitis: a variant of atopic dermatitis
Blicharz, L., Michalczyk, A., Maj, M., Czuwara, J., Olszewska, M., & Rudnicka, L. (2025) · Italian Journal of Dermatology and Venereology · doi:10.23736/s2784-8671.25.08001-6 · Cited by 9 · see citing works
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Trichotillomania Prevalence in an Arab Middle Eastern Population
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Children with trichotillomania in COVID‐19 outbreak
Öner, Ü. (2021) · Journal of Cosmetic Dermatology · doi:10.1111/jocd.14200 · Cited by 7 · see citing works
Natural Recovery in Trichotillomania
Grant, J., & Chamberlain, S. (2021) · Australian and New Zealand journal of psychiatry (Print) · doi:10.1177/00048674211066004 · Cited by 6 · see citing works
Self-citationImhof, R., Davis, D. M., & Tollefson, M. (2020) · Pediatrics in review · doi:10.1542/pir.2019-0009 · Cited by 3 · see citing works
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Beard Alopecia: An Updated and Comprehensive Review of Etiologies, Presentation and Treatment
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Salivary Inflammatory Markers in Trichotillomania: A Pilot Study
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Self-citationGenomics of Obsessive-Compulsive Disorder and Related Disorders
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Obsessive-Compulsive and Related Disorders
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Significance of family history in understanding and subtyping trichotillomania
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An overview of scalp dermatoses in a tertiary care institute
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Hazardous Alcohol Use in Trichotillomania
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Obsessive-Compulsive and Related Disorders
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Geriatric Psychodermatology: Current Concepts and Therapeutic Strategies
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- Authors
- Grant, J. E., & Chamberlain, S. R.
- Affiliations
- University of Cambridge (GB)
- Venue
- American Journal of Psychiatry
- Published
- 2016-09-01
- Volume
- 173
- Issue
- 9
- Pages
- 868-874
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC5328413
- OpenAlex
- W4239452805
- Cited by
- 252
- References
- 57
- Citations by year
- 2026: 23 · 2025: 37 · 2024: 25 · 2023: 26 · 2022: 31 · 2021: 49 · 2020: 26 · 2019: 15 · 2018: 11 · 2017: 8 · 2016: 1
- FWCI
- 15.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Funders
- Wellcome Trust (110,049/Z/15/Z, 110049)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Urology › Hair Growth and Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- trichotillomania, hair pulling, hair loss, obsessive-compulsive disorder, prevalence, habit reversal therapy, N-acetylcysteine, olanzapine, treatment options, DSM-5 classification
- MeSH terms
- Female, Humans, Psychotherapy, Trichotillomania, Young Adult
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