What Causes Trichotillomania?

hair pulling

Trichotillomania, or compulsive hair pulling, is a condition that affects two to three percent of the population in the U.S. Typically, it strikes first in the early teen years, but people as young as four and as old as 60 have been reported to suffer their first episode.

A question that has proven very difficult to answer is: What causes Trichotillomania?

The specific cause has yet to be found. Researchers and clinicians have postulated several possible areas for finding causes.

Psychological Causes

Many professionals have viewed trichotillomania as a disorder related to anxiety. For some reason, people with this condition tend to resort to hair pulling as a way to deal with the anxiety they feel. Possibly, the condition is related to obsessive-compulsive disorder in which the obsessive thoughts lead to anxiety that is relieved by the compulsive behavior of hair pulling. This relief is only temporary. The thoughts/anxiety return, leading to more compulsive behavior.

Others have suggested trichotillomania to be a learned behavior. Possibly a behavior similar to thumb-sucking in children. Along this line of thinking, it could be a response to some childhood trauma that brought on hair pulling instead of some other comforting behavior.

Another viewpoint says trichotillomania may be a form of self-harm, similar psychologically to cutting or other forms of self-mutilation. This possible cause appears to occur only rarely because the pain of hair pulling is so mild. In cases of cutting, the pain is much more intense and thus the “rush” related to pain is more significant than hair pulling.

One school of thought regarding psychological causes has to do with hair pulling behavior being a manifestation of an addictive disorder. This can be seen in its being used when rising tension occurs in an individual and that person then pulls hair to relieve the tension. The relief of tension serves as a negative reinforcer in much the same way that the use of drugs to relieve tension works.

Biological Causes

Another way of looking at trichotillomania is from a biological standpoint. There are a few theories about the biological causes of this condition. Research into this area of causes for the condition is still in the early stages.

One of these theories suggests the condition to be related to hormonal changes. This is supported by considering trichotillomania’s most prominent age for appearing. This is 11 years of age, the time when young pre-adolescents are just beginning to feel the hormonal changes that will mark their lives for the next several years. The use of hair pulling as a self-comforting behavior would increase at this time because of the psychological, emotional, and mood changes occurring.

Another biological theory has to do with lowered levels of serotonin in the brain. This neurotransmitter is also called the “feel-good” chemical. Support for this viewpoint has been found in the treatment of people with trichotillomania with medications that increase the levels of serotonin in the brain.

Another theory about biological causes of this condition stems from brain scans of some people with trichotillomania showing brain abnormalities. These abnormalities have been seen only on some sufferers with this condition. It does not mean everyone with trichotillomania has these brain abnormalities.

A research finding that appears to support biological causes of this condition came from research with mice. In this study, mice with mutated microglia in their brains experienced similar symptoms to trichotillomania. Interestingly, when these mice were treated with normal bone marrow transplants, the symptoms went away.


Current research into trichotillomania has focused on the genetic basis for the condition.

Many researchers believe there are multiple genes that increase the risk of developing this condition. Three genetic mutations have been studied as causes for trichotillomania. One of these mutations is in the SLITRK1 gene. Another is changes in the serotonin 2A gene. The third possible mutation has been seen in mice in the HOXB8 gene. Research into these genetic causes is still in the early stages, but does seem to suggest a combination of genetics may be at least a cause of the condition.

The SLITRK1 gene modulates growth of the brain cortex and neurons. Mutations appear to cause psychiatric conditions, and may lead to trichotillomania. The HOXB8 gene appears to affect grooming behavior in mice. A mutation leads to increased grooming. This increase in grooming behavior is very similar to hair pulling in humans.

Other research has focused on serotonergic (5-HT) and dopaminergic (DA) pathways. Both of these pathways are mediated by genes, thus are of great interest to those postulating a genetic basis for trichotillomania. Significant variations on 5-HT2A T102C were found on those subjects with this condition compared to healthy controls. Researchers believe these variations on T102C to be indicative of developing trichotillomania. It appears that variants on 5-HT2A may be involved in the modulation of impulses.

One finding of this research into the genetic basis of trichotillomania has been that the condition is most likely not caused by a single gene or mutation. Rather, a combination of genes and their mutations and the effect that has on behavior appears to be a better assumption for the cause of trichotillomania.

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