Trichotillomania of the Eyebrows

A lot of conditions can cause eyebrow loss, but trichotillomania of the eyebrows can be one of the most difficult to live with and to treat. Trichotillomania can cause hair loss anywhere on the scalp, face, or body. This disorder has been officially recognized only for a short time, and there isn’t yet much research about it.  Here are the highlights of what we do know.

What is Trichotillomania?

Trichotillomania (or trich) is a hair-pulling disorder marked by a recurrent and irresistible urge to pull out hair despite the negative consequences of the pulling and a desire to stop or cut back.

Common places for pulling are the scalp, eyebrows, and eyelashes, but trich can affect hair anywhere on the body.

People with trich may experience it differently. Some people notice rising tension followed by relief upon pulling, but that’s not necessary for the diagnosis. Other folks feel a sensation like a tingling or an itch right before pulling. In some people, hair pulling is focused (deliberate), and in others it’s automatic (not consciously done).

For diagnosis and insurance purposes, trich is classified as a psychiatric impulse control disorder, a label which may carry a stigma and make an already tough situation even worse.

Trich usually begins at or soon after puberty, though it can affect younger and older people. More females than males live with the disorder. Some folks have only one occurrence but for others, trich can resolve and then return later. From 1% to 2% of the population experiences trich in any given year.


The most noticeable sign of trichotillomania is one or more bald patches or thinned-out or uneven areas in the hair, eyebrows, eyelashes, or other exposed parts of the body.

Another symptom is pulling or twisting of hair, although some people with trich do this only when they’re alone.

Less obvious signs of trich are bald areas on parts of the body usually covered by clothing.

Other symptoms include poor self-image, denial of hair pulling, other acts of self-injury, sadness, depression, and anxiety.

Sometimes people with trich eat some or all of the hair they pull; in this case, bowel obstruction can be a symptom of the disorder.


Causes of trichotillomania are still unknown, but researchers have noticed a higher incidence of trich among people with obsessive-compulsive disorder (OCD) and folks whose first-degree relative has OCD.

Another theory is that trich is triggered or influenced by hormones.

Other proposed causes include a chemical imbalance in the brain or a genetic predisposition to the disorder. Some scientists believe trich may be a type of self-harm used to relieve stress or a coping mechanism to handle stress.


Research is currently limited, but the most effective intervention for trich is thought to be some combination of habit reversal training, cognitive-behavioral therapy, acceptance and commitment therapy, and/or medication (often SSRI antidepressants). Many people have used these tools to stop or reduce their hair pulling.

To grow eyebrows back, a person with trichotillomania of the eyebrows should of course do everything possible to leave them alone (much easier said than done!).

Almost as important as not pulling is to be patient (also easier said than done!).   A lot of people wonder, How long does it take to grow eyebrows back? Many eyebrow hairs will be starting to come in at three months, but it may take up to nine months for all hairs to grow. In the meantime, using a good eyebrow growth serum or oil can help provide an optimal environment to grow eyebrows back.

In severe cases, trichotillomania of the eyebrows can cause scarring and destruction of the hair follicles. If this happens, the affected hairs won’t grow back.

Destruction of follicles can occur anywhere on the body where hair is repeatedly pulled out by the root, but eyebrow hair follicles are known to be especially vulnerable to permanent damage.

There are a variety of treatments available that can give a person with trichotillomania of the eyebrows a more typical appearance and an improved self-image. These include

  • conventional cosmetics such as eyebrow pencils and powders
  • permanent cosmetics (also known as eyebrow tattooing, microblading, 3-D brows, or semi permanent cosmetics)
  • eyebrow extensions (tiny hairs individually attached to existing eyebrows with adhesive)
  • false eyebrows (also called fake eyebrows or eyebrow wigs)
  • eyebrow transplants (also known as eyebrow restoration)

The best choice depends on a lot of factors, such as a person’s age, gender, degree of eyebrow loss, lifestyle, budget, and individual preference. To get a good result with some of these options, it’s important for people to have entirely stopped pulling their eyebrows.

Taking Action

Trichotillomania of the eyebrows can be devastating.

The prominent position of eyebrows on the face and the importance of eyebrows in communicating emotions make them key to a person’s identity and expression. Trich is difficult to live with no matter where it occurs, but when the eyebrows are affected, it’s very hard to avoid unwanted attention.

Many times, because trich is more common in young people, it creates challenges for everyone else in the family.

With the existing medical and cosmetic treatments available, and more options being researched, it’s possible for people living with trichotillomania of the eyebrows to make positive changes.

It’s also invaluable to get information and support from other people going through the same thing. Here are some groups that can help:


Heart and Soul Academy: https://hasacademy.org/about
Trichotillomania Learning Center (renamed the TLC Foundation for Body-Focused Repetitive Behaviors): https://www.bfrb.org/

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