traction alopecia and trichotillomania

Traction Alopecia and Trichotillomania: What’s the Difference?

Hair loss can be a distressing experience, and it can be challenging to determine the cause of it. Two possible causes are Traction Alopecia and Trichotillomania. In this blog post, we will discuss the differences between Trichotillomania and Traction Alopecia, so you can better understand which one may be affecting your hair loss.

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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 at 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.

So, Which One Do I Have? Finally

When it comes to trichotillomania or traction alopecia, it is important to understand the differences between the two conditions in order to receive proper treatment and achieve successful hair regrowth. If you suspect that you may have either condition, consulting a healthcare professional will be the best way to determine what type of condition you have and create an effective treatment plan.

See our top 4 Causes of  Traction Alopecia hair extensions? or how to pre­vent Traction Alopecia with Hair Transplant and keep it from recur­ring.

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Written by Anthony Wedderburn:

Medically Team reviewed by Dr. Ljuba Zsolnai and updated. With professional help, Anthony research and only provide content that delivers results. The name "Stages of Balding" accurately reflects the blog's purpose: to provide practical solutions and guidance without requiring extensive research on the reader's part.
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