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For people with Down syndrome, family members, caregivers and professionals.

Trichotillomania (Hair Pulling)

April 2025 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Key Points

  • Trichotillomania is a mental health condition in a category called "body-focused repetitive behaviors."

  • It is characterized by frequent, repeated, and irresistible urges to pull out hair from the scalp, eyebrows, eyelashes, and other body areas.

  • The behavior may be used to reduce stress or anxiety.

  • Treatment includes various forms of behavioral therapy, stress reduction, and medications and/or supplements.

  • It does not appear to be more common in people with Down syndrome; however, the exact frequency in Down syndrome is not known.

 

What is trichotillomania?

Trichotillomania is a condition in which a person has frequent, repeated, and irresistible urges to pull out hair from the scalp, eyebrows, eyelashes, and other body areas.

It is in a category called “body-focused repetitive behaviors,” which are defined as mental health conditions in which the person performs self-grooming actions that unintentionally harm their body. There are several conditions that are in this category including trichotillomania.

Trichotillomania is related to obsessive compulsive disorder but different than it.

  • Trichotillomania arises from a desire to reduce tension, stress, or anxiety, or out of habit. It may be accompanied by a pleasurable sensation. 

  • Obsessive compulsive disorder is driven by obsessions (intrusive thoughts, urges, or images) that cause anxiety. Compulsions are performed to try to neutralize or prevent the feared outcome. 

 

Trichotillomania and Down syndrome

Trichotillomania does not appear to be more common in people with Down syndrome. We have only seen a few individuals with Down syndrome with trichotillomania. However, one small study reported a frequency of 4% (4 out of 100 children with Down syndrome in their study).

Overall, there is limited available information about trichotillomania in people with Down syndrome including treatment.

 

Underlying physical conditions

When a person has trichotillomania, it is important to determine if there are other reasons that explain why they pull at their hair. The initial assessment should include evaluation for an underlying physical condition that may be contributing to a need to touch or pull on the hair. The following conditions may be associated with skin irritation that can contribute to a need to touch, scratch, or pull on the hair:

  • Atopic dermatitis (eczema)

  • Scabies

  • Head lice

  • Psoriasis

  • Seborrhea

  • Hyperthyroidism (overactive thyroid)

  • Cholestasis (bile backs up due to obstruction of the biliary system; often associated with gallstones)

People lose hair for reasons that are not related to pulling on the hair. More information is available in the Possible Causes of Hair Loss article in our Resource Library.

 

Treatment

Treatment may include forms of behavioral therapy and medications.

  • Cognitive behavioral therapy (CBT) may include habit reversal training (HRT), comprehensive behavioral treatment, acceptance and commitment therapy, and dialectical behavior therapy (DBT).

  • Stress management and support groups.

  • Medications and supplements including selective serotonin reuptake inhibitors (e.g., sertraline, fluoxetine), clomipramine, or N-acetylcysteine (NAC)).

More information is available in the Resources section below.

 

Resources

Down syndrome

Gallstones

Hyperthyroidism (overactive thyroid)

Possible Causes of Hair Loss

Psychotherapy

Seborrhea

General

Body-Focused Repetitive Behavior Disorders (Cleveland Clinic)

The TLC Foundation for Body-Focused Repetitive Behaviors

Trichotillomania (Cleveland Clinic)

Trichotillomania (Mayo Clinic)

 

References

Daneshpazhooh M, Nazemi TM, Bigdeloo L, Yoosefi M. Mucocutaneous findings in 100 children with Down syndromePediatr Dermatol. 2007;24(3):317-320. doi:10.1111/j.1525-1470.2007.00412.x

Find More Resources

We offer a variety of resources for people with Down syndrome, their families and caregivers and the professionals who care for and work with them. Search our collection of articles, webinars, videos, and other educational materials.

View Resource Library

 

Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.

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