Pulled out hair root

Trichotillomania

Overcoming hair-pulling urges may involve a type of behavioral therapy called habit substitution, taking medicine, or a combination of therapy and medicine.

In therapy, people with trichotillomania learn about urges. They learn how urges fade on their own when people don’t give in to them, and how urges get stronger and happen more often when people do give in. They learn to identify situations, places, or times they usually have an urge to pull.

Therapists teach people with trichotillomania how to plan a replacement habit they can do when they feel a strong urge to pull hair. Replacement habits might be things like squeezing a stress ball, handling textured objects, or drawing. The therapist guides the person on how to use the new habit to resist the urge to pull hair. With practice, a person gets better at resisting the urge to pull. The urge becomes weaker and easier to resist.

Because the urges and habits that lead to hair pulling are so strong, resisting can be difficult at first. People may feel more tension or anxiety as they begin to resist urges to pull. A therapist can coach a person through these difficult parts and offer support and practical advice about how to reverse the powerful urges.

Sometimes medicines can help the brain deal better with urges, making them easier to resist. A therapist may also help people with trichotillomania learn to manage stress, deal with perfectionism, or work out other compulsive habits they may have, like nail biting.

If you’re worried about hair pulling, talk to a parent, school counselor, or someone you trust about getting help overcoming the problem.

Reviewed by: D’Arcy Lyness, PhD Date reviewed: March 2016

Trichotillomania (pronounced trik-o-till-o-MAY-nee-uh), also referred to as “hair-pulling disorder,” is a mental disorder classified under Obsessive-Compulsive and Related Disorders and involves recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling.

Hair pulling from the face can result in complete or partial removal of the eyebrows and eyelashes, while hair pulling from the scalp can result in varying degrees of patches of hair loss. The hair pulling and subsequent hair loss results in distress for the person, and can interfere with social and occupational functioning.

For some people, the symptoms of trichotillomania are manageable, but for others, the symptoms can be completely overwhelming.

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Symptoms of Trichotillomania

The primary feature of trichotillomania is recurrent pulling of one’s own hair. Hair pulling can occur in any region of the body in which hair grows; the most common sites include the scalp, eyebrows, and eyelids. Less common areas include facial, pubic, and peri-rectal regions.1

Other symptoms can include the following:

  • Repeated attempts to decrease or stop hair pulling
  • Hair pulling causes distress or impairment in social, occupational, or other areas of functioning
  • An increasing feeling of tension before the hair pulling, or when trying to resist pulling
  • A feeling of relief after pulling
  • Noticeable hair loss
  • Playing with pulled hair, or rubbing it across the face or skin
  • Biting, chewing, or eating pulled hair
  • Pulling certain kinds of hair (certain textures)
  • Hair pulling often occurs in private

Emotional States

Hair pulling may be triggered by or accompanied by a number of emotional states. It can be preceded by anxiety, boredom, stress, or tension, and can result in feelings of gratification, relief, or pleasure following the pulling.2

Hair pulling can also involve varying degrees of awareness.

Focused hair pulling: Some people engage in focused hair pulling with the intention of experiencing tension relief from pulling. In this case, the hair pulling can include specific rituals, including pulling certain types of hair.

Automatic hair pulling: Some people engage in hair pulling without fully realizing it. This can occur when they are bored, watching TV, or engaged in other mindless activities.

Mixed hair pulling: Many people engage in a mix of both behavioral styles.

Many individuals diagnosed with trichotillomania also have other body-focused repetitive behaviors, including skin picking, nail biting, and lip chewing.

Prevalence

The 12-month prevalence for trichotillomania in adults and adolescents is 1-2%, with a female to male ratio of 10:1. Among children, females and males are more equally represented.3

The onset of hair pulling most often coincides with or follows, the onset of puberty. The course of the disease is chronic, though individuals can experience symptoms that wax and wane over time.

There does appear to be a genetic component to trichotillomania. The disorder is more common among individuals with obsessive-compulsive disorder and their first-degree relatives than the general population.4

Risk Factors

  • Age: Onset typically occurs between the ages of 10-13 and can be lifelong
  • Other mental health disorders: People with trichotillomania often have anxiety, depression, or obsessive-compulsive disorder
  • Stress: High-stress levels may trigger trichotillomania for some individuals

When to Seek Help

If you can’t stop pulling your hair and you experience negative repercussions in your social life, school or occupational functioning, or other areas of your life because of it, it’s important to seek help. Trichotillomania won’t go away on its own. It is a mental health disorder that requires treatment.

Treatment of Trichotillomania

Treatment of trichotillomania can be complicated, and most treatment options require time and practice. Individuals often try several strategies to cope with their urges before they find something that works. Try not to get discouraged if symptoms come and go.

  • Habit reversal: This is often the primary treatment of trichotillomania. Individuals learn how to recognize situations where they are likely to pull hair and substitute other behaviors instead. Many people use journaling, alerts, and other strategies to increase awareness of triggers. Instead of pulling hair, a person might substitute behaviors such as; clenching fists or snapping an elastic band on the wrist.
  • Cognitive therapy: This type of therapy can help people explore distorted beliefs related to hair pulling.
  • Self-awareness training: Individuals learn to become more aware of their hair pulling patterns by tracking when they pull and detailing emotions and other important information.
  • Relaxation training: This helps people learn to focus on and calm their central nervous systems in response to stress triggers.
  • Deep breathing training: Learning the proper way to engage in deep breathing helps increase relaxation and focus.
  • Process-oriented therapy: Talk therapy can be effective in helping people explore their triggers and emotions beneath the pulling.
  • Medication: While there are no medications specific to the treatment of trichotillomania, SSRIs and SNRIs can be used to treat some of the accompanying symptoms of anxiety.
  • Family therapy: For children and adolescents, family therapy helps parents learn to better respond to and manage symptoms.
  • Group therapy: Trichotillomania can feel isolating. Groups help people connect with others enduring a similar struggle and provide support for one another.

Some individuals with trichotillomania learn to manage symptoms and triggers with outpatient treatment, while others require more intensive treatment. It’s important to seek help as soon as possible and continue treatment on an ongoing basis.

Article Sources Last Updated: Feb 13, 2018

Why Can’t I Stop Pulling My Hair?

Source: Claudio Terribile/

Pulling, twirling, plucking, twisting, tugging, or playing with your hair – are these all just harmless habits? It is reported that for an estimated 4% of the population, hair pulling is so much more than just a bad habit. The act of compulsively engaging in repetitive hair pulling that results in noticeable hair loss is classified in the Diagnostic and Statistical Manual (DSM5) as trichotillomania or compulsive hair pulling disorder. Trichotillomania, together with other compulsive behaviors such as compulsive skin picking and nail biting, fall under the umbrella term Body-focused Repetitive Behaviors (BFRBs). However these compulsions do not suddenly appear overnight. Those who suffer with these disorders are often unable to pinpoint exactly when the behavior first started. It is a behavior that may very well have started out as a habit, but through repeated engagement and some form of positive reinforcement the habitual hair pulling eventually evolves into a disorder.

From Habit to Disorder

First we must address the question, “what is a habit?” According to the Oxford English Dictionary, a habit is “a settled or regular tendency or practice, especially one that is hard to give up”, and in psychological terms it is “an automatic reaction to a specific situation”. Many people with hair pulling disorder would be able to relate to the definition of a habit as an apt description of their experience with hair pulling. However, even though bad habits are undesirable or have a negative impact on your general well being, it does cause significant dysfunction. The combination of the person not being able to stop engaging in the behavior despite wanting to, with significant functional impairment, signals the onset of a clinical disorder.

How do I know if I have Trichotillomania?

According to the DSM5, the diagnostic criteria for trichotillomania consists of:

  • Recurrent hair pulling resulting in noticeable hair loss
  • Repeated attempts to decrease or stop hair pulling
  • The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The hair pulling is not attributable to the psychological effects of a substance (e.g., cocaine) or another medical condition (e.g. alopecia)
  • The hair pulling is not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body-dysmorphic disorder, stereotypes in stereotypic movement disorder or tics)

Hair pulling can be targeted at any part of the body where there is hair – scalp, eyelashes, eyebrows, even the pubic area. The compulsion can be so severe that the individual can spend hours pulling. Not only does this have a negative impact on the person’s day-to-day functioning, the after-effects of a pulling episode often includes feelings of shame and guilt. trichotillomania can be an extremely debilitating condition, but is often misunderstood by those who are not afflicted by the disorder. Friends and loved ones, with good intentions, often tell the person to ‘just stop’ as there is the perception that all it requires is the power of will.

Source: Ryan McGuire/

Can it be treated?

Unfortunately there is still very little awareness of trichotillomania and other BFRBs so these disorders often go undiagnosed and those suffering with the disorder are left feeling alone, ashamed and embarrassed by their behavior. As with all mental illness, awareness of your condition and acknowledgement that your suffering is due to a recognized clinical condition is the first and most important first step to recovery. There are many advocacy and support organizations such as the Trichotillomania Learning Centre (TLC) who are working hard to increase awareness about the disorder among the greater public, and to advance the knowledge, understanding and expertise among health professionals. Trichotillomania is a chronic condition. Much like a physical chronic condition like diabetes, it is a condition that must be managed not cured. But there is hope. Cognitive Behavioral Therapy (CBT) has proven to be the most effective form of therapy in treating BFRBs including Trichotillomania. We still have a long way to go in our understanding of this this condition, but we have made a start and there have many successes with the knowledge we have thus far.

Trichotillomania: Why You’re Pulling Your Hair Out

You have been pulling your hair out since you were a kid. You are ashamed that you do this and you want to stop, but you feel a constant hair-pulling urge. Or you may not even realize when you do it. You may have trichotillomania.

Trichotillomania is a type of mental health condition known as an impulse control disorder. Impulse control disorders are conditions in which you have strong, uncontrollable urges to take part in self-destructive behaviors. Pyromania (the urge to set fires) and kleptomania (the urge to steal) are other examples of impulse control disorders.

Is Stress Behind Your Hair Loss?

Researchers are not sure exactly what causes impulse control disorders such as trichotillomania. But it is believed that chemical imbalances in the brain are likely to be involved. And there also may be a genetic component, since trichotillomania sometimes runs in families.

Symptoms of Trichotillomania

Symptoms of trichotillomania are not always the same. Some people pull their hair out in large clumps, while others pull out one strand at a time. Some people with trichotillomania are aware that they are pulling their hair out, and even get a pleasurable sensation when they do it — sometimes likened to scratching an itch. But others do it unconsciously without even thinking about it. Some people tend to inspect the hair strand after pulling it, and some put the strand in their mouth, and may even swallow the hair.

People with trichotillomania may pull hair out of their scalp or from their eyebrows, eyelashes, or other parts of their body.

In general, common trichotillomania symptoms include:

  • Repeatedly pulling out hair by the root
  • Bald spots or noticeable hair loss
  • Sensations in the scalp or skin that are only relieved by hair pulling
  • A build-up of tension along with an urge to pull out hair
  • A satisfying feeling associated with pulling out hair
  • Shame or embarrassment about hair pulling, even denying what they are doing

Who Has Trichotillomania?

Trichotillomania is a relatively rare condition, affecting between 1 and 4 percent of Americans.

Trichotillomania affects more women than men. Most people with trichotillomania began pulling their hair out during adolescence, around the age of 12 or 13. But people can begin hair pulling as early as age 1, and it can also start later in life.

Treatment Options and Coping With Trichotillomania

If you suspect that you or a loved one has trichotillomania, see your doctor. He can rule out other conditions that may be resulting in hair loss, and give you options for managing trichotillomania.

Trichotillomania is a mental health condition, and most people will need professional help to learn how to control their hair pulling impulses. Common treatment options for trichotillomania include:

  • Cognitive-behavioral therapy. In cognitive-behavioral therapy (sometimes called “talk therapy”) for trichotillomania, a therapist will teach you how to recognize the growing urge to pull out your hair, and learn how to manage it before it becomes too strong. You may learn that certain situations trigger your hair-pulling urges, and you can avoid or modify these situations.
  • Medications. Sometimes doctors prescribe medications, such as selective serotonin reuptake inhibitors (SSRIs), to help people control their hair pulling urges. These medications alter your brain chemistry to make it easier to resist hair-pulling impulses.
  • Behavioral modification. Your doctor may recommend that you find things to do with your hand, such as squeezing a stress ball or knitting, at times when you are likely to have a strong urge to pull out your hair.

The Psychological Effects of Hair Loss

Overcoming trichotillomania can be difficult. In addition to working with your doctor to help manage your condition, it can help to join a support group made up of other people who are in a similar situation as you. The Trichotillomania Learning Center provides a listing of trichotillomania support groups around the world.

White Bulb on Hair Follicle – A Sign of Hair Loss?

While the loss of hair with a white bulb attached can be a normal occurrence, you may have reason to worry if the loss of such hair is excessive.

This can be an indicator of telogen effluvium or pattern baldness and, without treatment, can worsen.

In this post, I’ll break down the structure of the hair strand, as well as the hair growth cycle. You’ll learn what the white bulb is, and whether its presence on the base of your fallen hair is a sign of hair loss.

In addition, I’ll show you a few ways you can put an end to excess hair loss, and ways to treat conditions related to telogen thinning, including stress relief and diet overhaul.

The White Bulb – What Is It?

The one thing that scares people about the presence of a white bulb is its confusion with the root. After all, hair grows from the root, so no root means no more hair growth.

There’s good news however; the bulb is not the root itself. Instead, it’s the part of the hair strand that is the closest to the root throughout the growth cycle.

When a bulb is present on the end of a hair strand, all it means is that the hair was lost at the root. This is indicative of a telogen phase hair, and it doesn’t mean Male-Pattern Baldness (MPB) or other types of hair loss (such as alopecia areata) in and of itself (1, 2).

It also doesn’t mean that further hair growth cannot occur (as loss of telogen hair does happen naturally during the hair growth cycle).

But what happens when hair is lost without the bulb?

All hair lost at the root will contain a bulb. It may be small or large, white or pigmented. However, the bulb is always present when it comes from the source (that is, the follicle).

A hair without a bulb, then, means that the hair was lost prior to the root. This is caused by premature breakage, typically a result of tension or physical stress. A few things that can lead to hair breakage include:

  • Stretching (caused by tight hairstyles or wet styling)
  • Protein deficiency
  • Vitamin/mineral deficiency
  • Overexposure to sun
  • Heat styling
  • Dyes/perms

Through the strengthening of your hair, you can easily avoid premature breakage. But are there ways to combat excess hair loss when it occurs at the root?

The Hair Cycle

To better understand the role that the bulb plays in hair loss, it’s important to understand the process of hair growth.

There are four main phases of the cycle of hair growth (3). These include:

  1. Anagen. This is the phase of active growth, and it lasts anywhere from two to six years. At this point in the cycle, rapid cell development is occurring. This results in the formation of the lower portion of the follicle, known as a bulb.
  2. Catagen. As the transition phase, active growth ceases and the hair follicle begins to be pushed from the papilla. This lasts from a few days to a few weeks.
  3. Telogen. This is the resting phase, where very minimal cell activity is taking place. At this point, a new anagen hair is forming under the surface and will soon push the telogen hair (along with the white bulb) from its follicle.
  4. Exogen. The stage in which telogen hairs are shed, and newly-formed anagen hairs push through the follicle. During this stage, 50 – 100 hairs are lost per day.

One thing to keep in mind is that your hairs are at different points in the cycle. While anywhere from 70 – 85 percent of your hairs are currently in anagen phase, another 5 – 15 percent are currently in telogen phase.

This means that hair loss should be fairly consistent throughout the year (unless, of course, you suffer from hair loss).

White Bulb and Hair Loss – Are They Connected?

If it’s normal for a white bulb to be present on the end of a telogen hair shaft, does this mean that hair loss is imminent?

No.

While an increase in hair loss is indicative of present (and perhaps future) hair loss, it doesn’t necessarily mean you’re doomed.

So, if hairs with white bulbs aren’t a good indicator of hair loss, what are some signs you can look out for?

  • Excess shedding (as seen on pillow or in shower drain)
  • Hairline recession (especially near the temples)
  • Itchy, flaky scalp
  • Thin, wispy hair

Of course, another possible indicator of hair loss is a genetic predisposition. Now, just because your male relatives suffer from hair loss doesn’t mean you will. However, it’s best to err on the side of caution and pre-treat the condition.

As mentioned above, the presence of white bulbs doesn’t always mean that hair loss is an issue. However, there is a condition characterized by excessive hair loss while in the telogen phase. Let’s take a closer look.

Telogen Effluvium

One condition characterized by loss during the telogen phase is known as telogen effluvium. The name literally means “telogen outflow.”

This occurs when too many hairs on the scalp enter telogen prematurely, and active growth ceases. This results in diffuse (all around) thinning.

Unfortunately, not much is known about this condition. This includes why some people are more susceptible than others. However, a few of the known causes are:

If you’ve noticed an increase in hair loss with a white bulb presence on the end, you may very well be suffering from this condition. Fortunately, this condition and usually short-lived and can be treated in a number of ways.

How to Stop Thinning and Hair Loss

If you’ve noticed an increase in your hair loss, there are some things you can do to put an end to the nightmare. Let’s take a closer look.

Change Your Diet

Your hair – just like other parts of your body – requires proper nutrition and mineral support. This means that a diet lacking in necessary vitamins and minerals can lead to acute (or even chronic) hair loss.

Fortunately, effluvium caused by diet deficiencies can be reversed.

First and foremost, it’s important to pinpoint your body’s nutritional needs. This will vary from person to person (depending on gender, weight, BMI, age, and other such factors) but can be determined with the help of a trained medical professional (such as a dietitian).

Second, you’ll need to have the dedication to perform an entire diet overhaul. This can be difficult for some, but it’s an absolutely essential step if you’re looking to put an end to hair thinning and loss.

A few of the foods I recommend you rid from your diet immediately include:

  • Dairy: This food group is one that can cause delayed allergic reactions and can be difficult to digest after pasteurization. This means consumption can lead to systemic inflammation and digestive imbalance.
  • Carbonated drinks: High in sugar and acid-forming, carbonated beverages add no nutritional value to your diet but instead
  • Sugary cereals: Foods that are high on the glycemic index – such as sugary cereals and grains – lead to spikes in blood sugar. Over time, this can lead to insulin resistance (which may be linked to early-onset Androgenetic Alopecia) (4).
  • Greasy foods: A diet high in greasy foods can clog the pores and hair follicles; this leads to hair miniaturization, blood flow restriction, and eventual hair loss.

With these foods removed from your daily rotation, it’s time to add in some more filling and nutrient-dense choices. Some of the best additions to your diet include foods that are:

  • High fiber
  • Probiotic
  • Low glycemic
  • Plant based

With these foods added to your diet, you can ensure that your body (and your hair) is getting the nutrients it needs. This will help to improve overall health and contribute to stronger, more stable hair.

Take a Breather

As stress is a major cause of telogen hair loss, one of the best things you can do to put an end to it is taking part in stress-relieving activities.

One such activity is controlled breathing.

Through calm and intentional breaths, you can lower cortisol levels and increase oxygen intake. This will decrease free radical activity (which can lead to further signs of aging, including hair loss and wrinkles) and improve the growth of healthy hair.

Other forms of stress relief exist as well. These include meditation, yoga or tai chi, massage, and many more. Choose to manage your stress and include self care.

Stimulate the Scalp

The above two techniques are beneficial for long-term health and hair growth. But if you want to take a more direct route to stopping hair fall, consider scalp stimulation.

Scalp stimulation is physical manipulation of the scalp that takes place in various forms. The most popular include massage, scalp exercises, and microneedling.

And best of all, scalp stimulation has proven to be beneficial in combating hair loss. How?

As briefly mentioned above, there are various parts of the hair follicle that play a role in hair growth. One of the more important structures, though, is the dermal papilla.

The dermal papilla is the structure at the base which connects the follicle to blood vessels. These blood vessels deliver oxygen and nutrients and, as such, a strong connection is critical.

By stimulating the scalp, you can naturally increase blood flow to the follicles and ensure adequate oxygen and nutrient levels.

But there’s one more benefit to scalp stimulation, and to microneedling in particular: cell proliferation (5).

According to a study performed in 2013, microneedling is able to stimulate hair growth in men with AGA (6). This has even been shown to be successful in men who had previously failed to respond to other hair loss treatments (7). This procedure does involve a needle entering the skin and has the same risks as a tattoo. Please research your practitioner for training and certification in your state, and ensure that sterile disposable needles are used.

While you won’t see immediate results, you can use scalp stimulation in conjunction with the other methods mentioned above for a more thorough approach.

The Bottom Line

The loss of hair containing a bulb is a completely natural occurrence. In fact, such hairs can be shed anywhere from 50 – 100 times per day. However, a problem occurs when more hair than that is shed.

Whether through AGA, telogen effluvium, or alopecia areata, an increase in hair lost with a white bulb attached can be treated. This will involve a natural, multi-step approach (such as the one outlined above).

This article was medically reviewed by Debra Rose Wilson, PhD MSN RN IBCLC AHN-BC CHT

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Information contained on this website has not been evaluated by any medical body such as the Food & Drug Administration. All information is for educational purposes only. We do not aim to diagnose, treat, cure or prevent and disease or illness. You must consult a medical professional before acting on any content on this website.

Cure for thinning hair? Scientists find plucking stimulates huge growth

“The work leads to potential new targets for treating alopecia, a form of hair loss,” said Cheng-Ming Chuong Professor of pathology at the Keck School of Medicine of the University of Southern California.

“It is a good example of how basic research can lead to a work with potential translational value.”

Previous research by dermatologists had shown that when hair follicles are damaged it affects the adjacent skin and tissue and influence hair regeneration. It is the reason that vigorously massaging the scalp is recommended, for hair growth.

To test whether they it was possible to stimulate the scalp enough so that follicle growth was activated, the researchers plucked 200 follicles, one by one, from the back of a mouse.

When the area was more than 6mm, nothing happened. But scientists discovered that if plucking area was kept below 5mm, the hairs not only grew back but regrew in greater abundance in the plucked area and outside of it.

Plucking from circular areas with diameters between three and five millimeters triggered the regeneration of between 450 and 1,300 hairs.

Through molecular analyses, the team showed that these plucked follicles signal distress by releasing inflammatory proteins, which recruit immune cells to rush to the site of the injury.

These immune cells then secrete signalling molecules which communicate to both plucked and unplucked follicles telling them that it’s time to grow hair.

It works on the principle of “quorum sensing,” in which an entire system responds to stimuli that affect some, but not all members. It explains how social animals like ants and bees work together as one entity.

In this case, quorum sensing underlies how the hair follicle system responds to the plucking of some, but not all hairs.

And scientists think that the effect may not be confined to just hair. There is a chance that causing slight damage to other organs or parts of the body may stimulate a burst of regrowth.

“The implication of the work is that parallel processes may also exist in the physiological or pathogenic processes of other organs, although they are not as easily observed as hair regeneration,” added Prof Chuong.

Dr Bessam Farjo, founder of the Farjo Hair Institute and Medical Director of the Institute of Trichologists, said: “Hair loss affects millions of people in the UK, whether it’s caused by male or female-pattern baldness, alopecia areata or other issues, such as hair shedding.

“Whilst it’s certainly interesting to see the results of this study in mice, all previous observations suggest that repeatedly plucking a human hair follicle will weaken the root, and eventually cause the follicle to die. People pluck hairs – such as eyebrows – out all the time, and it doesn’t seem to stimulate the growth of other hairs.

“It’s great to see scientists putting resource to studies of this sort, but more scientific tests and human evidence are needed to substantiate the findings of this initial report.”

The research was published in the journal Cell.

Photo:

It can be alarming to look at your comb or at the shower drain and see a clump of hair. Not only could it clog your drain, but you may worry that it’s a sign of serious hair loss. But chances are what you’re seeing isn’t anything to be concerned about, and if you want to be sure, there are easy ways to check for abnormal hair loss at home.

The average person loses somewhere between 50 and 100 strands of hair per day, according to the American Academy of Dermatology. Yes, that’s a lot, so don’t panic if you see a few strands in your bathroom.

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Hair shedding versus hair loss

And while we’re on the topic, there is a difference between hair loss and hair shedding. The AAD notes that hair shedding—or temporarily losing a little more hair than usual—is completely normal, and usually occurs after a major life stressor or body change, like losing 20 lbs. or more, giving birth, having a high fever, going off birth control pills, or caregiving for a loved one. Excessive hair shedding usually lasts for six to nine months, and then your hair growth and loss returns to normal.

Hair loss, on the other hand, is when something happens that actually stops your hair from growing, the AAD explains. Examples of this include hereditary hair loss, losing hair because of a medication like chemotherapy, using harsh hair care products, or having a compulsion to pull out your own hair. In these cases, the hair will not regrow until the cause stops—though that’s not possible in every case (like if genetics are to blame). If you have questions about the difference between hair shedding and hair loss, it may be a good idea to talk to your doctor.

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That said, if you want to test your own rate of hair loss, here are two ways to check:

Pull test

For a simple at-home test, Dr. James C. Marotta suggests you take about 60 hairs between your fingers and pull a little bit as you run your fingers through your hair. It’s normal to see five to eight hairs in your hand. If you have 15 to 20 hairs, though, you could be losing more hair than normal. Marotta explains:

“For most, 90 percent of the hair on your head is in the growing phase, while about 10 percent of your hair is in the ‘resting’ phase, meaning that 10 percent will fall out and leave room for new hair growth within a certain period of time. If you are losing more than 15 hairs per pull, it likely means more than 10 percent of the hair on your head is in the ‘resting’ phase.”

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Comb test

Here’s another test to try: before shampooing, comb from the back of the top of your head forward to the front of the scalp for one minute. Do this while leaning over a lightly colored bed sheet, then count the hairs on the sheet. According to a study published in the Journal of the American Medical Association: Dermatology, you should see about 10 hairs.

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Of course, there are a few caveats for both of these methods, including that these numbers are approximate and may differ between people with different types of hair. Also, we tend to lose more hair as we age, which again, is normal. But the general idea is to know what’s normal for you so you can tell when it has gotten worse.

This story was originally published on 11/17/16 and was updated on 8/28/19 to provide more thorough and current information.

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1. Telogen effluvium

Telogen effluvium is a temporary condition that can occur after pregnancy, major surgery, drastic weight loss, or extreme stress, in which you shed large amounts of hair every day, usually when shampooing, styling, or brushing. During telogen effluvium, hair shifts faster than usual from its growing phase into the “resting” phase before moving quickly into the shedding (or telogen) phase. “High stress environments prevent the body from giving hair the TLC that it needs, causing hair to shed and fall out,” Dr. Goldenberg says.

✔️The symptoms: Women with telogen effluvium typically notice hair loss six weeks to three months after a stressful event. At its peak, you may lose handfuls of hair. “It can be very distressing,” Dr. Goldenberg says.

✔️The tests: There are no tests for telogen effluvium, but your doctor may ask you about recent life events and look for small “club-shaped” bulbs on the fallen hair’s roots. The bulbs mean the hair has gone through a complete cycle of growth, suggesting that the cycle may have sped up due to stress.

✔️The treatments: In some cases, such as after pregnancy or major surgery, you may have to bide your time until the hair loss slows. “It usually resolves. But, in some women, it can become more chronic,” says Dr. Goldenberg. Your best bet? Find a way to unwind to lower your stress levels (These science-backed ways to relieve stress are a good place to start.)

Taking a hair growth vitamin or supplement—such as biotin or other forms of vitamin B—may also be helpful, says Dr. Goldenberg. Just check in with your doctor first to make it won’t interfere with any other medications you may be taking.

2. Hereditary hair loss

Genetic hair loss or thinning is known as androgenetic alopecia and is the most common cause of hair loss, according to the American Academy of Dermatology (AAD). The gene can be inherited from either your mother’s or father’s side of the family, though you’re more likely to have it if both of your parents had hair loss.

✔️The symptoms: The condition develops slowly and may start as early as your 20s, and women with this trait tend to develop thinning at the hairline behind the bangs, says Pamela Jakubowicz, MD, a board-certified dermatologist at Montefiore Medical Center in New York City. Another red flag is a widening part, and the hair loss may be diffused, meaning it’s spread across the entire scalp.

✔️The tests: Your dermatologist will examine the pattern of hair loss to determine if it’s hereditary and order blood work to rule out other causes, Dr. Jakubowicz says. A biopsy of your scalp is sometimes done to see if the hair follicles have been replaced with miniaturized follicles, a surefire sign of hereditary hair loss.

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✔️The treatments: While there’s no way to completely prevent hereditary hair loss, you can slow the thinning by applying minoxidil (aka Rogaine)—the only FDA-approved ingredient found to improve hair loss—to the scalp twice a day. It works by enhancing the size of the follicles, resulting in bigger strands of hair. (Just note that women should not use minoxidil if they are pregnant or nursing.)

Men may be treated with minoxidil or finasteride (Propecia), an oral medication. “I also recommend a multivitamin with biotin, zinc and copper,” Dr. Goldenberg says. He’s also seen success in his patients with a treatment called platelet rich plasma injections, a procedure in which your blood is drawn and then placed into a machine to separate the red blood cells from plasma. This plasma—which is “rich in platelets that contain growth factors,” per the AAD—is then injected into the hair follicles directly.

3. Alopecia areata

Alopecia areata is an autoimmune disorder in which the immune system attacks hair follicles. It may affect up to nearly 7 million people in the United States and occurs in all genders, ages, and ethnicities. The cause is unknown, but it may be triggered by stress or illness, Dr. Goldenberg says.

✔️The symptoms: The condition can occur in three forms. Alopecia areata commonly causes round, smooth patches of baldness on the scalp, eyebrows, or legs, Dr. Fusco says. Total hair loss on the head is known as alopecia totalis, while hair loss that occurs all over the body is called alopecia universalis. “Some patients have reported that before the bald spot occurred, they felt something in that area—a tingling or an irritation,” Dr. Fusco says.

✔️The tests: Observing the pattern of hair loss can usually determine if you have alopecia areata, as can blood tests. You may also be given a test to measure your hormones to rule out underlying conditions that may cause hair loss.

✔️The treatments: Alopecia areata is usually treated with intralesional corticosteroids, Dr. Fusco says. For more advanced cases, there are also promising clinical studies involving JAK inhibitors like oral tofacitinib (Xeljanz) that has resulted in regrowth for some. Minoxidil (Rogaine) may also help. It’s also important to reduce stress.

4. Medication side effects

Certain medications, like some cholesterol-lowering drugs, blood pressure drugs, warfarin (an anti-coagulant), psoriasis medications, anti-seizure medication, and anti-arrythmia drugs all have hair loss as a potential side effect, says women’s health expert Jennifer Wider, MD.

✔️The symptoms: You may find that you start to lose your hair three months or so after you begin a new medication.

✔️The tests: Talk to your doctor about specifics. The type of medication you’re taking will determine what they test for, although your doctor may also look into whether you have an underlying condition, just to be safe.

✔️The treatments: Your doctor may recommend switching to another medication, Dr. Wider says, or supplementing with something else to try to minimize the side effects.

5. Thyroid problems

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Thyroid problems are common in women, especially over the age of 50, says Los Angeles-based endocrinologist Theodore C. Friedman, MD, MPH. In fact, 1 in 8 women will develop a thyroid disorder in her lifetime, according to the American Thyroid Association.

Your thyroid—the small, butterfly-shaped gland that sits at the base of your neck—is responsible for producing thyroid hormone, which is responsible for everything from your basal metabolic rate—the rate at which your body uses oxygen and energy to function—to the growth of your hair, skin, and nails.

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But when you don’t have the right amount, you may notice changes in bodily functions. When too little is pumped out, you are said to have hypothyroidism, or an underactive thyroid. If your body makes too much of the hormone, you’re said to have hyperthyroidism, or an overactive thyroid.

✔️The symptoms: Hypothyroidism (too little hormone) may cause a host of symptoms, including unexplained weight gain, fatigue, constipation, depression, and difficulty concentrating. Hair, nails, and skin may become more brittle and break more easily. Hyperthyroidism (too much hormone) is less common than hypothyroidism, but may cause inexplicable weight loss, heart palpitations, nervousness, irritability, diarrhea, moist skin, and muscle weakness. Both much or too little thyroid hormone can affect your hair follicles freak out, resulting in hair loss.

✔️The tests: A blood test measures thyroid-stimulating hormone (TSH), which is produced by the pituitary gland in an attempt to coax the thyroid to make thyroid hormone. Excess TSH usually indicates hypothyroidism, while abnormally low levels suggest hyperthyroidism.

✔️The treatments: “Fixing thyroid imbalances is an important part of the treatment,” Dr. Goldenberg says. Thus, your doctor may prescribe a thyroid hormone medication to restore levels to normal. Regular TSH tests might be done to ensure an adequate dosage.

6. Iron deficiency anemia

An iron deficiency seems like an unusual reason for hair loss, but women can “absolutely” have hair loss while struggling with this, Dr. Goldberg says. Women who have heavy periods or don’t eat enough iron-rich foods may be prone to iron deficiency, in which your body doesn’t create enough hemoglobin, a protein that transports oxygen to the tissues in your body. In turn, your red blood cell count drops quickly, zapping your energy. About 10 million people in the United States are iron deficient, per one 2013 review of research, and it’s more common in women than men.

✔️The symptoms: Iron deficiency anemia causes extreme fatigue, weakness, and pale skin. You may have difficulty concentrating and also notice headaches, or cold hands and feet. Any type of exertion may leave you short of breath. Your hair may also start to thin and fall out, Dr. Goldenberg says.

✔️The tests: A blood test to measure ferritin, the protein that stores iron in your body, is usually needed to diagnose iron-deficiency anemia. Your doctor may also check your blood level of hematocrit, which gauges how much of your blood is made up of red blood cells.

✔️The treatments: Eat iron-rich foods such as beef, pork, fish, leafy greens, fortified cereals, and beans—preferably, along with foods rich in vitamin C, which enhances iron absorption. Women need at least 18 milligrams of iron a day and 8 milligrams after menopause. While supplementation may be necessary, you should talk to your doctor about recommended dosage before popping a pill.

7. Polycystic ovary syndrome

As many as five million women in the United States suffer from polycystic ovary syndrome (PCOS). The condition, which can begin as early as age 11, is caused by a hormonal imbalance in which the ovaries produce too many male hormones. PCOS often causes infertility.

✔️The symptoms: PCOS can cause facial hair growth, irregular periods, acne, and cysts on the ovaries. And while you may experience hair loss on your scalp, you may notice more hair elsewhere on the body, Dr. Fusco says.

✔️The tests: Your doctor is likely to do a blood test to look for elevated levels of testosterone and DHEAS (dehydroepiandrosterone), a by-product of testosterone.

✔️The treatments: Most cases of PCOS are treated with birth control pills such as Yasmin, which contains a potent anti-androgen that blocks testosterone. If you can’t use birth control pills, your doctor may prescribe spironolactone (Aldactone), which also blocks male hormones. Losing weight can also help by decreasing the effect of the male hormones.

You may need to be patient while your your hair comes back. “When hormonal conditions like PCOS are treated, it may take several weeks to months for associated hair loss may improve,” says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City.

8. Psoriasis, dandruff, and other skin conditions of the scalp

An unhealthy scalp can cause inflammation, and “if the inflammation is deep in the scalp, it can cause hair loss,” Dr. Goldenberg says. Skin conditions that lead to hair loss include seborrheic dermatitis (dandruff), psoriasis, and fungal infections such as ringworm.

✔️The symptoms: Seborrheic dermatitis causes the scalp to shed its skin, so you’ll notice greasy, yellowish scales on your shoulders or in your hair. It may be the result of yeast called Malassezia, hormonal changes, or excess oil in the skin. Scalp psoriasis, an autoimmune condition that causes excessive skin cell turnover, produces a very thick white scale that can bleed if pulled off.

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With ringworm, a fungus you contract by touching an infected person or animal, you’ll notice red patches on your scalp, which may be diffused, Dr. Jakubowicz says.

✔️The tests: A physical exam of the scalp will help determine which condition you have. A fungal culture and possibly a biopsy of the scalp may pinpoint ringworm. Just don’t wait on this. “If you already have inflammation, itching, hair breakage or hair loss, see your dermatologist to make sure it’s not a more serious skin condition,” Dr. Goldenberg says.

✔️The treatments: Each condition usually requires a prescription: a medicated shampoo for dandruff, medications or light therapy for psoriasis, and oral antifungals for ringworm.

9. Excessive styling

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Too much shampooing, styling, and dying can harm your hair, leading to hair breakage and loss, Dr. Goldenberg says. Often, it’s a combination of treatments—keratin, coloring, and blow-drying, for instance—that does the damage.

✔️The symptoms: If the fallout is occurring from external damage caused by styling, it will simply break, and you won’t see those club-shaped telogen bulbs at the ends.

✔️The tests: Dr. Jakubowicz does a pull test: She takes a small handful of about 50 strands, pulls gently, and checks to see whether the hair that comes out has bulbs on the ends.

✔️The treatments: Avoid using appliances that overheat your hair. Set your hair dryer on cool and low settings and minimize your use of flat and curling irons (say, for special occasions). If you use hair gel or hair spray, don’t wait for it to dry before you comb through it, because the hair will harden and be more likely to break.

If you must dye your hair, consider pivoting just one or two shades from its normal color: The more severe the color change, the more chemicals you require—resulting in excess breakage.

10. A low-protein diet

While it’s rare for people living in developed countries to have a protein deficiency, if you’ve recently become a vegan or vegetarian and haven’t worked enough plant-based proteins into your diet, it’s possible you may not be getting enough of the nutrient.

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When this happens your body may ration whatever protein is already in your body by shutting down hair growth, according to the AAD. This typically occurs two to three months after your protein intake dips.

✔️The symptoms: In addition to hair loss, a protein deficiency may cause bloating, brittle nails, fatigue, and weakness. When your hair breaks, you won’t see those club-shaped telogen bulbs at the ends.

✔️The tests: If your doctor is worried a lack of protein may be to blame for your thinning hair, he or she may do a blood draw for a total protein test, which measures of all of the proteins in your blood.

✔️The treatments: Eating more protein will likely stop the hair loss, Dr. Goldenberg says, since a lack of protein is a form of malnutrition, which stresses the body. Meat, eggs, and fish are excellent sources of protein, as are many plant-based foods, including tofu, legumes, nuts, and tempeh.

11. Menopause

Menopause is a normal condition that affects women as they age. By definition, menopause is a point in time 12 months after a woman’s last period, per the National Institute on Aging (NIA). During this time, your body produces less estrogen and progesterone hormones.

✔️The symptoms: Everyone experiences menopause differently, but you may notice symptoms like hot flashes, trouble sleeping, moodiness, irritability, pain during sex, and depression, the NIA says. Hair loss can also be an issue. “During menopause, hair loss occurs because of the changes in hormones,” says Dr. Wider. “When estrogen and progesterone drop, the result is a slow down of hair growth and a thinning of hair in many women.”

✔️The tests: Your doctor may suggest a blood test to check your follicle-stimulating hormone and estradiol levels to rule out any other causes for the changes you’re going through, the NIA says.

✔️The treatments: “It’s important to treat your hair well and gently during this time,” Dr. Wider says. “Avoid extreme heat with hair dryers and ironing tools. Use mild shampoos and conditioners without added chemicals. Keep your body hydrated.” If that doesn’t help, talk to your doctor about medication options.

12. Dramatic weight loss

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“Studies have shown that rapid or significant weight loss can trigger hair loss,” Dr. Wider explains, commonly due to the deprivation of certain nutrients, including protein.

✔️The symptoms: You’ll notice if you start to lose weight quickly (typically defined as losing more than 5 percent of your weight in six months to a year). Your pants will be looser and, if you weigh yourself regularly, you’ll see the number on the scale go down. If you’re experiencing hair loss, it can come on suddenly.

✔️The tests: If you’re not trying to lose weight, your doctor may recommend blood tests to see what’s behind your rapid weight loss—which may include things like simply not eating enough, thyroid issues, celiac disease, or even mental health disorders like depression.

✔️The treatments: If you’re trying to lose weight, talk to your doctor about any vitamin deficiencies that could be behind your hair loss. If not, and there is an underlying condition behind your weight loss, know this: “Once a person regains the weight, the hair loss will stop and begin to grow back” after the appropriate treatment is determined, Dr. Wider says

13. Lupus

Lupus is a chronic autoimmune disease in which the body’s immune system attacks its healthy tissues. The condition affects about 1.5 million Americans, according to the Lupus Foundation of America, and tends to strike women during their childbearing years.

✔️The symptoms: Lupus often causes extreme fatigue, headaches, oral ulcers, and painful, swollen joints. Many people develop a butterfly-shaped rash across the bridge of the nose and become more sensitive to the sun. Other symptoms include fever, swelling in the feet and hands and around the eyes, chest pain, and anemia.

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Many people with lupus also experience hair loss, which may be mild and occur while shampooing or brushing your hair—or it may be more severe, coming out in patches and accompanied by a rash on the scalp, says Arthur Weinstein, MD, director of the division of rheumatology at the Washington Hospital Center. Because these symptoms occur in many other conditions, lupus is often called the great imitator.

✔️The tests: A rheumatologist will examine joints and other tissues for signs of inflammation, such as heat, pain, swelling, and redness. A blood test to measure levels of anti-nuclear antibodies (ANA) may also indicate lupus. Rheumatologists will also determine if patients have four of 11 diagnostic criteria set by the American College of Rheumatology, though fewer criteria along with a skin biopsy may sometimes indicate lupus, Dr. Weinstein says.

✔️The treatments: See a rheumatologist if your hair loss is accompanied by joint pain, fatigue, or other symptoms of lupus. If you also have a rash on the scalp, you need to see a dermatologist, who is likely to prescribe a topical cream.

14. Chemotherapy

Chemotherapy works to kill cancer cells in your body, but it can also kill off healthy cells in the process, including ones behind hair growth. “Chemotherapeutic agents target rapidly growing cells (like cancer) in order to stop the growth,” Dr. Wider says. “Unfortunately, they also target healthy cells like hair cells and, as a result, a person in chemotherapy can lose their hair.”

✔️The symptoms: You’ll may notice thinning hair and/or hair that falls out in clumps.

✔️The tests: You probably won’t need any, given that hair loss is a common side effect of chemotherapy.

✔️The treatments: There is a fairly new FDA-approved treatment called a cooling cap that can help. Scalp cooling is thought to prevent hair loss by reducing blood flow to hair follicles, per the National Cancer Institute. When the scalp is cooled, blood vessels constrict, and that can limit the amount of chemotherapy drug that reaches hair follicles.

15. Trichotillomania

Trichotillomania is a condition that causes an overwhelming urge to repeatedly pull out your own hair, according to the National Organization for Rare Disorders (NORD), causing hair loss. While this can impact hair all over your body (including eyebrows and eyelashes), hair on the scalp is most commonly affected.

✔️The symptoms: Symptoms generally include constant hair-pulling and an urge to pull your hair. People with the condition also may feel tension before they pull and a release afterward, NORD says. Because the scalp is a main point of pulling, people with trichotillomania may focus on one or two areas, resulting in bald patches. The condition can be very distressing.

✔️The tests: People are usually diagnosed with trichotillomania after a doctor does a clinical evaluation, takes a detailed patient history, and rules out other potential causes of hair loss.

✔️The treatments: Trichotillomania is usually treated with psychotherapy and medication, NORD says. Psychotherapy usually includes cognitive behavior therapy, which tries to identify and alter the thoughts and emotions that causes a person to pull their hair. Several medications, including clomipramine, n-acetyl cysteine, and olanzapine may also help.

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Korin Miller Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more.

Why I pull out my hair

Sometimes after pulling I look at a hair closely, confirming its imperfect, bumpy shape and seeing if the root is intact. On a day when I’ve been puzzling over something, I often find hairs all over my desk, outlining the papers or books I’ve been reading like the chalk at a grisly murder scene.

I can’t remember when this started. I’ve certainly always been partial to squeezing a zit or plucking an eyebrow. In my 20s I could (not exactly happily) spend an entire evening tweezing out one hair at a time from my underarms or bikini line. Pulling hurts, but only temporarily. And once that hair’s out, I feel an odd relief.

This quirk – trichotillomania, or ‘trich’ – is one of several recognised body-focused repetitive behaviours. Others are skin picking and cheek or lip biting.

Researchers think that compulsive hair pullers do their thing to counteract over- or understimulation. Boredom is a definitely a trigger for me. In the way you might tap a foot or fiddle with something, my go-to is my scalp. Conversely, when I’m trying to understand something difficult I’m reading, I find the predictable, repetitive sorting through my hair soothing.

Left hand, right hand, left hand, right hand.

Because of my pulling, I have a small bald patch in the middle of my head. As the hairs grow back, I get a halo of shorter hair that sticks up on top. It’s a bit of a vicious cycle, as these are then in prime picking position.

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