Body-Focused Repetitive Behaviors (BFRBs)

Definition ⁽⁸⁾

Trichotillomania (pronounced trick-o-till-o-may-nee-uh, often referred to as “trich” or TTM) is a mental health disorder characterized by the repetitive pulling of one’s hair, commonly from the scalp or eyebrows, but can occur on any part of the body that grows hair.
Individuals with trichotillomania feel an irresistible urge to pull out their hair and even when trying to resist the urge, feel like they cannot stop.
Often resulting in patchy bald spots, this behavior can cause a lot of distress and affect school, work, and social life. Individuals may also try to hide their hair loss, further resulting in emotional distress.

The Diagnostic and Statistical Manual of Mental Disorders (5th edition) recognizes hair-pulling disorder as the following ⁽¹⁾:

• Recurrent hair-pulling causing hair loss
• Repeated attempts to decrease or stop hair pulling
• Significant distress in social, occupational, or other important areas of functioning
• Not otherwise attributable to another medical condition (e.g., a dermatological condition)

Due to genetic links between trichotillomania and obsessive-compulsive disorder (OCD), trichotillomania is classified as an obsessive-compulsive related disorder (OCRD) in the DSM-5 ⁽³⁾.

Signs and Symptoms ⁽⁴⁾

• Noticeable hair loss
• Thinning or bald spots
• Missing eyelashes, eyebrows, or body hair
• Lack of conscious control: often no awareness that the behavior is occurring until after the fact
• Due to shame and embarrassment, many individuals with trichotillomania try to cover up their hair loss (e.g., wearing scarves, hats, or avoiding windy days)
• After pulling hairs, some individuals with trich lick, bite, or eat the hairs

By the Numbers

• Lifetime prevalence is estimated between 1.1% and 1.7% (3–6 million people in the U.S.) ⁽⁸⁾
• About 9 in 100 people exhibit broader hair-pulling behaviors (not fully meeting DSM-5 criteria) ⁽⁸⁾
  • If visible hair loss isn’t required: 12 in 100 people
  • If visible hair loss is required: 5 in 100 people
• Typically develops in late childhood or early puberty ⁽⁸⁾
• Occurs equally in men and women, but by adulthood 80–90% of reported cases are women (Phillips)
  • Women and men experience trichotillomania at similar rates, but women are more likely to have hair loss ⁽⁸⁾

Common Comorbidities ⁽⁹⁾

• Generalized anxiety: 59%
• Depression: 55%
• Obsessive-Compulsive Disorder (OCD): 29%
• Attention Deficit Hyperactivity Disorder (ADHD): 29%
• Post-Traumatic Stress Disorder (PTSD): 29%

Cause ⁽⁸⁾

The exact cause of trichotillomania is unknown and more research is needed to understand why individuals engage in this behavior.
Contributing factors include genetics, developmental influences, and psychological factors.

Possible Effects and Complications ⁽⁸⁾

Individuals who ingest their hair can experience serious health effects such as pruritus, tissue damage, and infection. Ingested hair may cause gastrointestinal distress or digestive blockage known as a trichobezoar, which can require surgical removal.

Definition ⁽²⁾

Excoriation (commonly known as skin-picking disorder and formerly known as dermatillomania, pronounced derm-ah-till-oh-main-ee-ah) is a mental health condition where one frequently picks or scratches at their skin, causing unintentional injuries or scarring ⁽²⁾.

The Diagnostic and Statistical Manual of Mental Disorders (5th edition) recognizes skin-picking disorder as the following ⁽¹⁾:

• Recurrent skin picking resulting in skin lesions
• Repeated attempts to decrease or stop picking
• Significant distress in social, occupational, or other important areas of functioning
• Not otherwise attributable to another medical condition (e.g., a dermatological condition)

Signs and Symptoms ⁽⁵⁾

• An urge or physical tension prior to picking
• Negative emotions about how your skin should look and feel
• Relief or pleasure after picking
• Lack of conscious control: often no awareness that the behavior is occurring until after the fact
• Due to shame and embarrassment, many individuals with a skin-picking disorder try to cover up the results (e.g., wearing long sleeves, applying makeup, or avoiding situations where others may see affected areas)

A comprehensive evaluation from a licensed clinician should be sought to determine an accurate diagnosis and to rule out other psychiatric or dermatological conditions.

By the Numbers

• Skin-picking can affect men and women of all ages, though it is slightly more common in women and younger adults ⁽²⁾.
• About 1.7% of men and 2.3% of women are currently affected.
• Approximately 2% of people currently have skin-picking disorder, and 3% have experienced it at some point in their lifetime ⁽²⁾.

Common Comorbidities ⁽²⁾

• Generalized anxiety: 63%
• Depression: 53%
• Panic disorder: 28%
• Post-Traumatic Stress Disorder (PTSD): 27%
• Obsessive-Compulsive Disorder (OCD): 26%
• Attention Deficit Hyperactivity Disorder (ADHD): 24%

Cause ⁽⁵⁾

The exact cause of excoriation disorder is unknown, and more research is needed to understand why individuals engage in this behavior.
Contributing factors may include genetics, developmental influences, and psychological factors.