International Journal of Trichology

: 2018  |  Volume : 10  |  Issue : 6  |  Page : 289--290

Plucking, picking, and pulling: The hair-raising history of trichotillomania

Rachel LV Waas1, Paul Devakar Yesudian2,  
1 Department of Dermatology, Ysbyty Glan Clwyd, Rhyl, UK
2 Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK

Correspondence Address:
Dr. Rachel LV Waas
Department of Dermatology, Ysbyty Glan Clwyd, Rhuddlan Road, Bodelwyddan, Rhyl LL18 5UJ

How to cite this article:
Waas RL, Yesudian PD. Plucking, picking, and pulling: The hair-raising history of trichotillomania.Int J Trichol 2018;10:289-290

How to cite this URL:
Waas RL, Yesudian PD. Plucking, picking, and pulling: The hair-raising history of trichotillomania. Int J Trichol [serial online] 2018 [cited 2023 Jan 30 ];10:289-290
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Trichotillomania is an impulse-control disorder characterized by an irresistible desire to pull hair in response to stress or tension, leading to a sense of relief. The term trichotillomania was derived from the Greek words for “hair,” “to pull,” and “madness.” Although this term was conceived in 1889 by the French Dermatologist Francois Henry Hallopeau[1] (1814–1892), the practice of hair-pulling has been described far back in history.

Hair-pulling was first documented by Aristotle in the 4th Century BC in his renowned philosophical work “Nicomachean Ethics.”[2] In Book VII, Continence and Incontinence: Pleasure, he discusses self-control, vices, and brutishness. In Chapter 5, he references the habit of plucking out hair and gnawing nails.

Hippocrates (or associates), in Epidemics III (410 BCE ca), reported on the case of Thasos, wife of Delearces.[3] Following a grief-stricken episode, he described her having periodic fevers where she would wrap herself up and pluck, scratch, and pick hairs.

This act was also well described in the Bible.[3] In the Old Testament, Ezra Chapter 9: Verse 3 the following passage is found “When I heard this, I tore my tunic and cloak, pulled hair from my head and beard and sat down appalled.” Ezra's hair-pulling was in response to his extreme disappointment at the people of Israel marrying outside the Hebrew community. The tearing of hair from his head represented an outward symbol of his frustration. Furthermore, in response to the same matter, another Old Testament prophet, Nehemiah's reaction was “I rebuked them and called curses down on them. I beat some of the men and pulled out their hair. I made them take an oath in God's name and said: 'You are not to give your daughters in marriage to their sons, nor are you to take their daughters in marriage for your sons or for yourselves.'” (Nehemiah 13:25). Nehemiah's rage led him to use hair-pulling as a form of punishment.

The practice has also featured in celebrated historic literary works. In William Shakespeare's famous tragedy, Romeo and Juliet, Romeo expressed his aggravations to Friar Lawrance, “Thou canst not speak of that thou dost not feel. Wert thou as young as I, Juliet thy love. An hour but married, Tybalt murdered. Doting like me, and like me banished. Then mightst thou speak, then mightst thou tear thy hair. And fall upon the ground, as I do now. Taking the measure of an unmade grave” (Act 3, Scene 3).[3],[4] Here, Shakespeare used the act of tearing hair out to emphasize the deep exasperation Romeo felt.

Although the act of hair-pulling is currently attributed to a psychiatric disorder, historically, it has been described both as a punishment and as a somewhat violent expression of one's own disillusionments, frustrations, and disappointments. Hair-pulling was a physical extension of internal turmoil, which is perhaps akin to what we understand as the underlying etiology of trichotillomania today. While the compulsive urge of pulling hair out is reserved nowadays to the disorder of trichotillomania, colloquially, we often speak of “tearing our hair out” as a metaphor for exasperation which reflects the circumstances of its historical documentation.

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1Hallopeau H. Alopecia by scratching (trichomanie ou trichotillomania). Ann Dermatol Syphiligr 1889;10:440-1.
2Ross D, Brown L. Aristotle the Nicomachean Ethics. 2nd ed. New York: Oxford University Press; 2009.
3França K, Chacon A, Ledon J, Savas J, Nouri K. Pyschodermatology: A trip through history. An Bras Dermatol 2013;88:842-3.
4Kim WB. On trichotillomania and its hairy history. JAMA Dermatol 2014;150:1179.