Trichotillomania: A Body-Focused Repetitive Behavior

By: Lauren Zoneraich

Trichotillomania, also known hair-pulling disorder, is a chronic psychological condition in which one feels the urge to pull out pieces of hair from the scalp, eyebrows, eyelashes, and other body areas.  Hair pulling can be an intentional or an unconscious behavior. Some people purposely pull their hair because it produces a pleasurable feeling. Hair pulling relieves stress, anxiety, sadness, and tension for people with trichotillomania. A motivation for pulling hair may simply be to relieve the urge to pull hair. Others may unconsciously pull their hair when they are relaxed or distracted. Hair-pulling causes the formation of bald spots and the thinning of hair, which induces anxiety and distress in people with trichotillomania. People with trichotillomania may feel ashamed and embarrassed about their appearance, which may lead to low self-esteem and the avoidance of certain social activities in which they must expose their head.

About 2% of people experience trichotillomania in their lifetime. Trichotillomania is categorized under “Obsessive-Compulsive and Related Disorders.” Symptoms and signs of trichotillomania include:

  • Repeatedly pulling out hair
  • Tension before pulling or when resisting the urge to pull
  • Pleasure or relief after pulling out hair
  • Hair loss, hair thinning, balding
  • Rituals for hair-pulling, such as a preferred spot to pull from
  • Biting, chewing, or eating pulled out hair
  • Inability to stop pulling out hair
  • Social distress related to hair-pulling

A possible pharmacological treatment for trichotillomania is N-acetylcysteine (NAC), an amino acid which targets glutamate levels in the nucleus accumbens, which is the reward center of the brain. The nucleus accumbens also houses neural circuits involved in aversion. Glutamate is an excitatory neurotransmitter, which means that it activates these pathways in nucleus accumbens. Altering glutamate levels may alter the strength of reward responses to certain behaviors, which may allow patients to decrease unwanted behaviors. In a study, researchers found that 56% of subjects reported improvement to their trichotillomania after 9 weeks of taking NAC. NAC can be bought at nutrition and health stores. This was a relatively small study, so more research must be done to determine the clinical effectiveness of NAC.

If you or someone you know is struggling with trichotillomania or skin-picking, please contact our psychotherapy offices in New York or New Jersey to talk to one of our licensed professional psychologists, psychiatrists, psychiatric nurse practitioners, or psychotherapists at Arista Counseling & Psychotherapy. Contact our Paramus, NJ or Manhattan, NY offices respectively, at (201) 368-3700 or (212) 722-1920 to set up an appointment. For more information, please visit


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