Hair loss: Could it be a psychological disorder?

For some time now, the child had looked unkempt. His hair was straggly and there were small bald patches on his head. Worried, his mother took him to see a doctor and was shocked when she was told that he had been pulling his hair out. The boy, it seemed, had been doing it in secret, but he couldn’t say why he did it. He just needed to, he said. Apart from this unusual habit, there was nothing wrong with him.

According to ​Dr Lee Haur Yueh, Consultant (Head), Department of Dermatology, Singapore General Hospital​ (SGH), a member of the SingHealth group.

, pulling his hair out was not a harmless habit that the boy would eventually grow out of. It is a condition known as trichotillomania, which affects mostly young teenagers struggling to come to terms with the physical, emotional and other changes that adolescence brings.


Trichotillomania: Psychological disorder causing self-inflicted hair loss​

A harrowing and rare psychological disorder, trichotillomania compels victims to pluck hair from their bodies – usually from the scalp, but also from eyebrows, eyelashes or even the pubic area.

“It is usually a manifestation of an obsessive compulsive disorder, but can also be associated with depression and anxiety,” said Dr Lee, who has treated patients as young as 10.

“Parents may think this is a mere habit and scold the child. They need to understand that the hair-pulling may be an outward sign of something psychological. The child has an immense urge to pull out his hair and is not at ease until he does it. Then, he feels tremendous relief and release of tension.”

Because the child often pulls his hair in private, parents are usually shocked when told of the diagnosis. They may also find it difficult to accept that the child has what is essentially an underlying psychological disorder. But the young patient needs plenty of support and understanding from his parents, said Dr Lee. Many of them have difficulty coping with stressful school examinations or strained family relationships, he added.

An obsessive compulsive ​behaviour

Trichotillomania patients may display other obsessive-compulsive behaviours like compulsive nail-biting or the repeated picking of skin. The constant hair-pulling can lead to permanent hair loss especially if the behaviour is left unchecked and continues for a long time.

The child often gets trapped in a destructive circle. “They pluck their hair and get bald spots. They then get made fun of or bullied. They become more isolated and stressed. To find relief, they pluck out even more of their hair. It’s stressful for both child and parent,” said Dr Lee.

Click on page 2 to find out more about an extreme form of trichotillomania, treatment, and other ​types of hair loss in adults.



Ref: S13​​