Trichotillomania and Substance Abuse

Trichotillomania, or self hair pulling, can be a symptom of substance use or underlying psychiatric disorder. Learn more about the link between trichotillomania and addiction.

Trichotillomania is a diagnosable psychiatric condition where individuals compulsively pull their head, eyelash or eyebrow hair. Most cases of trichotillomania involve these three areas, and people with trichotillomania feel pleasure or relief from hair pulling. They can also feel significant tension and anxiety when they are unable to pull their hair.

Patients may seek care — often from a doctor or dermatologist — after noticing bald patches or skin disturbances. The symptoms and consequences of trichotillomania can be distressing, although many patients may be unaware of or in denial about the self-induced hair loss.

Effects of Drug Use on Trichotillomania

Trichotillomania can be a coping strategy for stress and anxiety or an obsessive behavior related to a psychological condition. Research suggests that drug use can also increase hair-pulling behaviors, and hair pulling may be a sign of a substance use disorder.

Stimulants and Trichotillomania

People using stimulants like cocaine may experience tactile hallucinations, like bugs crawling over their arms, as well as heightened anxiety or stress. The effects of stimulants on hair-pulling compulsions can last from hours to days. These feelings may be temporarily alleviated by hair- pulling and often subside once the effect of the drug wears off or a person is no longer using the substance.

Trichotillomania, Alcohol and Cigarettes

Alcohol has the opposite effect of stimulants and may be used as a coping strategy for feeling on-edge or low. Evidence suggests that rather than making hair pulling worse, alcohol is often used to cope with negative feelings related to hair pulling. Since it slows the activity of the nervous system, alcohol may also be used to reduce the urge to hair-pull. Some people with trichotillomania may also use cigarettes to soothe anxiety or obsessions related to the need to hair-pull. While drugs and alcohol may be used as a coping strategy to deal with the discomfort of hair pulling, people with trichotillomania may abuse these substances over time.

Statistics on Trichotillomania and Addiction

Most commonly, mental health problems such as depression and anxiety co-occur with trichotillomania. Trichotillomania has also been linked to impulsive behavior and sensation seeking, which are both often present in substance use disorders. Trichotillomania itself has been considered a form of addiction, as those with trichotillomania may experience withdrawal or difficulty stopping hair-pulling behaviors.

Treating Trichotillomania and Co-Occurring Substance Use Disorders

The approach for treating trichotillomania depends on the cause of hair pulling, including underlying mental health conditions or substance use disorders. There is a range of treatment strategies available, including:

• Medication, such as selective serotonin reuptake inhibitors (SSRIs)
• Behavioral strategies to bring attention to pulling, like Band-Aids on fingers
• Developing new stress-management and coping strategies

To discuss treatment for co-occurring trichotillomania and substance abuse, reach out to The Recovery Village today. We will discuss possible treatment plans to get you on the road to recovery. 

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more