Is it traction alopecia or trichotillomania?

Diag­nos­ing the causes of hair loss is not always easy and is best left to the pro­fes­sion­als. But even doc­tors can some­times strug­gle with deter­min­ing the rea­sons behind a par­tic­u­lar patient’s con­di­tion. Some con­di­tions can appear sim­i­lar on the sur­face, although they have very dif­fer­ent rea­sons behind them.

Trac­tion alope­cia and tri­chotil­lo­ma­nia are two hair loss con­di­tions that are both caused by force­ful pulling and tug­ging at the hair. But while trac­tion alope­cia is a phys­i­cal con­di­tion caused by poorly under­stood effects of overly tight hair­styles, tri­chotil­lo­ma­nia is an impulse con­trol dis­or­der, often requir­ing psy­chi­atric treat­ment, rather than merely a hair loss treat­ment. It’s impor­tant to know the dif­fer­ence between the two, as both con­di­tions can affect chil­dren and each requires a dif­fer­ent type of treatment.

Trac­tion alopecia

This con­di­tion is the result of wear­ing the hair in styles that are too tight, result­ing in con­stant pulling and weak­en­ing of the hair shafts and fol­li­cles. This can speed up the shed­ding of hairs in the final stage of their growth, result­ing in a thin­ning of the hair. Fol­li­cles, on the other hand, can become trau­ma­tised, which keeps them in a dor­mant stage and pre­vents them from pro­duc­ing new hairs. In severe cases that are untreated, scar­ring can occur which may mean per­ma­nent hair loss in the affected areas.

Peo­ple who suf­fer from trac­tion alope­cia are gen­er­ally not aware of the fact that the way they style their hair is the cause of their hair loss. The appear­ance of trac­tion alope­cia is there­fore not an indi­ca­tion of a poor men­tal state or emo­tional problems.

Trac­tion alope­cia is usu­ally present at the front of the hair­line or around the edges of the scalp (banded trac­tion alope­cia), but if the hair is worn in rollers overnight a lot, it can also present itself as the hair falling out in clumps. When try­ing to diag­nose this type of hair loss, it’s there­fore impor­tant to note which hair­styles are worn by the suf­ferer on a reg­u­lar basis.


This type of impul­sive con­trol dis­or­der is not nearly as com­mon as trac­tion alope­cia. Only 4% of the pop­u­la­tion suf­fer from it, but women are far more likely to suf­fer than men. The exact causes of this con­di­tion are unknown.

Peo­ple with tri­chotil­lo­ma­nia suf­fer from repeated urges to pull out their own hair with­out the abil­ity to stop, even when the hair loss becomes severe. Usu­ally the hair pulled is the hair on the head, but some peo­ple may tug at eye­lashes, eye­brows or body hair.

Symp­toms usu­ally start early on in life, usu­ally by the age of 17. They can con­tinue through­out the patient’s life­time. Tri­chotil­lo­ma­nia often man­i­fests as an uneven appear­ance of the hair with bald patches or miss­ing clumps of hair. Addi­tional symp­toms are often present, which should hint of the men­tal state that is behind the condition.

These could include anx­i­ety, other self harm­ing behav­iour, or depres­sion. Although patients usu­ally deny the hair pulling when ques­tioned, it’s impor­tant to try and assess the men­tal con­di­tion of the patient, in order to see whether tri­chotil­lo­ma­nia is the cause. Usu­ally, doc­tors will per­form other tests to rule out other causes for the hair loss.

See our top 10 causes of trac­tion alope­cia or how to pre­vent it from recur­ring.

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