Characteristics of 60 adult chronic hair pullers

Am J Psychiatry. 1991 Mar;148(3):365-70. doi: 10.1176/ajp.148.3.365.


Objective: This study was constructed to detail the demographic and phenomenological features of chronic hair pullers as well as to assess psychiatric comorbidity in a sizable study group.

Method: Subjects were drawn from an outpatient population of chronic hair pullers who had been referred to a trichotillomania clinic or had responded to a newspaper advertisement announcing a treatment study of adults who pull out their hair. Sixty adult chronic hair pullers completed a semistructured interview that focused on their hair-pulling behavior and demographic characteristics and that incorporated screening questions for DSM-III-R axis I disorders. The data were tabulated to derive a comprehensive picture of this group.

Results: The typical subject was a 34-year-old woman who had pulled hair from two or more sites for 21 years. All subjects described either tension before or relief/gratification after pulling hair from the primary site, but 17% (N = 10) failed to describe both of these characteristics and thus failed to fulfill the DMS-III-R criteria for trichotillomania. Forty-nine subjects (82%) qualified for past or current axis I diagnoses other than trichotillomania. Several characteristics of the study group suggested phenomenological differences between obsessive-compulsive disorder and trichotillomania.

Conclusions: Adult trichotillomania is a chronic disorder, frequently involving multiple hair sites, and is associated with high rates of psychiatric comorbidity. Its relation to obsessive-compulsive disorder requires further clarification. The tension-reduction requirement in DSM-III-R for the diagnosis of trichotillomania may be overly restrictive.

MeSH terms

  • Adult
  • Age Factors
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Middle Aged
  • Self Mutilation / diagnosis
  • Self Mutilation / epidemiology
  • Trichotillomania / diagnosis*
  • Trichotillomania / epidemiology
  • Trichotillomania / psychology