Trichotillomania is a condition involving frequent urges to pull out one’s hair. Experts now consider it closely related to OCD due to the obsessive-compulsive nature of the disorder.
Mental health experts now classify hair-pulling disorder, or trichotillomania, as an OCD-related disorder because of the significant overlap between the conditions, such as frequent, repetitive compulsions that significantly interrupt daily life.
Because of trichotillomania’s proximity to obsessive-compulsive disorder (OCD), understanding both conditions can help guide you and your mental health professionals toward a path to healing. Here’s what to know.
Is trichotillomania related to OCD?
Up to 2% of people worldwide have trichotillomania.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) , trichotillomania is considered an obsessive-compulsive related disorder.
The DSM-5-TR notes trichotillomania used to be considered an impulse-control disorder, but in 2022, experts noted that, like with OCD, people with trichotillomania typically:
- try to quit the behavior repeatedly
- don’t perform hair pulling due to another condition, such as a skin disease
- feel significant distress from the hair pulling
OCD includes a large portion of diverse disorders that center on the theme of repeated thoughts and activities. Trichotillomania falls into this category while also having significant overlap with anxiety disorders.
Furthermore, scientists note there are similar changes in the brain in people with OCD and trichotillomania, including reduced cerebellum volumes and a thickening of the right frontal lobe.
Similar to compulsory behaviors in OCD, trichotillomania typically manifests as an overwhelming compulsion to pull hair.
Keep in mind that while OCD used to be considered its own condition, experts have expanded its definition in the DSM-5-TR. OCD is now considered its own diagnostic class.
Disorders in the obsessive-compulsive class include:
However, the authors of a 2020 review argue that trichotillomania is more closely related to Tourette syndrome than to OCD. According to the review authors:
- Unlike OCD, trichotillomania typically lacks clear obsessions that drive the hair-pulling behavior. While people with OCD typically believe that performing a compulsion (e.g., washing their hands 10 times) will soothe an obsession (e.g., to be completely bacteria-free), people with trichotillomania lack the obsessive, thought-based component. People with Tourette syndrome also typically perform tics for unknown reasons.
- More people with OCD also have tic disorders than trichotillomania. About 28.2% of people with OCD also have tic disorders, 8.4% also have Tourette syndrome, and 6.9% also have trichotillomania.
- Selective serotonin reuptake inhibitors (SSRIs), which are effective for treating OCD, tend to be inconsistent in treating trichotillomania. On the other hand, researchers point out that antipsychotics , which are effective for treating tics, tend to work well for treating trichotillomania.
That said, there’s a lot of overlap between tic disorders, Tourette syndrome, and OCD, so it’s possible that the manifestation and treatment of these conditions are more complex and multifaceted than what current research reveals.
Also, keep in mind that some very common manifestations of OCD, such as “just right” OCD, lack a clear motive for the behavior other than a person’s desire for things to be “just so.”
Likewise, people with trichotillomania may sometimes have underlying obsessions or repetitive thoughts that drive their behavior, which researchers simply haven’t yet studied.
If you experience a feeling of tension before pulling the hair and relief when you pull it out, for instance, your condition may be more related to a tic disorder. If you feel little relief after the action, your condition may be more related to OCD.
Is trichotillomania comorbid with any other conditions?
According to a 2024 review , trichotillomania often occurs alongside other mental health conditions, including:
According to the review, a majority of people with trichotillomania reported that their hair pulling is more distressing than their other conditions, like OCD, ADHD, and PTSD.
This could be because of the potential visible manifestation of the condition, which can lead to significant social discomfort or shame.
Examples of trichotillomania symptoms within OCD
Symptoms of OCD-related trichotillomania include:
- an overwhelming compulsion to pull out the hair
- significant distress or impairment in day-to-day life due to the behavior
- potentially, obsessive thoughts that lead to the hair pulling
Some people with trichotillomania may have a similar cognitive distortion pattern to people with OCD: Some people with trichotillomania have a fear of social interaction. The hair-pulling behavior is a way to reinforce their fear. Now, they have a reason to avoid social interactions — the bald patches of hair — which reinforces the cycle.
Obsessive thought patterns can be extremely varied, complex, and illogical, but they’re not at all uncommon.
If you have trichotillomania, remember that many people experience harmful thought patterns and behaviors and they are no reason for shame. Remember, you are not your thoughts. They do not have to define you.
Treating OCD and trichotillomania together
Effective treatments for OCD and trichotillomania include the following :
- Cognitive behavioral therapy (CBT) is a first-line treatment for both conditions. It involves helping people identify and challenge distorted thought patterns, develop strategies to manage urges, and improve their overall quality of life.
- Acceptance and commitment therapy (ACT) helps people understand their urges, distance themselves from obsessive thoughts , and feel encouraged to take actions aligned with personal values.
- Habit reversal training can help increase awareness of hair-pulling triggers, teach alternatives to hair pulling, and provide strategies for managing urges.
- Selective serotonin reuptake inhibitors (SSRIs) are effective at treating OCD in particular, with less effectiveness for trichotillomania. However, if you and your doctor suspect your symptoms are more closely tied to OCD, SSRIs may help.
- Antipsychotics have some effectiveness in treating OCD and trichotillomania. They’re also highly effective for tic-related disorders. If you and your doctor suspect your condition is more closely related to a tic disorder like Tourette syndrome, antipsychotics may lend the most relief.
- N-acetylcysteine supplements may help treat both OCD and trichotillomania, according to the International OCD Foundation (IOCDF) . Glutamate imbalance may contribute to OCD, and this supplement can help correct the imbalance. In preliminary studies, glutamate helped people with OCD, trichotillomania, and skin-picking disorder. More research is needed to know its effectiveness for sure.
If you suspect that someone you care about has trichotillomania, here are some tips for addressing the subject as kindly and compassionately as possible.
Takeaway
Trichotillomania is a complex disorder that shares many features with OCD, including overwhelming compulsions and significant disruptions in day-to-day life.
Treatment may include therapy like CBT or medication like antipsychotics. If you have trichotillomania, remember that support is available. Visiting a therapist is an excellent first step toward healing.
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