The Relationship of Menstrual Cycle and Pregnancy to Compulsive Hairpulling

Background: Trichotillomania (TTM) or compulsive hairpulling is a cyclical disorder that presents predominantly in females. Anecdotal reports of symptom worsening in the premenstruum and during pregnancy led us to retrospectively study the role of these events in hairpulling behavior. Methods: Questionnaires assessing demographics, current hairpulling behavior, and the reported effects of menstruation and pregnancy on urges, actual hairpulling and behavioral control were administered to clinic patients and volunteers at a hairpulling conference. The MGH Hairpulling Scale, Beck Depression Inventory and Beck Anxiety Inventory were also completed. Data from 59 hairpullers were analyzed. Results: Premenstrual symptom exacerbation was reported for actual hairpulling, urge intensity and frequency, and ability to control pulling and was alleviated during menstruation and shortly thereafter. The impact of pregnancy was less unidirectional, with both symptom exacerbation and lessening reported. Conclusions: The menstrual cycle appears to affect compulsive hairpulling and deserves recognition in both the assessment and treatment of this disorder. The impact of pregnancy on TTM is less clear.