What Is Trichotillomania, And How Does It Affect You?

Medically reviewed by April Justice, LICSW
Updated June 2, 2024by BetterHelp Editorial Team
Please be advised, the below article might mention trauma-related topics that include suicide, substance use, or abuse which could be triggering to the reader.
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Trichotillomania is often a serious disorder that can be difficult to overcome. In simple terms, trichotillomania generally refers to hair-pulling, but it can be more complicated than it sounds. Those with this disorder may often experience an uncontrollable impulse that causes them to pull on their hair to get relief. Often, the best type of treatment options for trichotillomania involves a combination of habit reversal training and acceptance and commitment therapy. You can seek out a licensed therapist who has experience with these types of therapy in your local area, or you may connect with one through an online therapy platform.

This article explores risk factors that might trigger trichotillomania, potentially related disorders, and options like cognitive therapy. 

Getty/Vadym Pastukh
Do you experience compulsive hair-pulling?

What is trichotillomania or hair-pulling disorder?

You may have a sibling who used to tug on your hair as a sign of affection or a way of teasing, or you may be someone who twists or plays with their hair when feeling embarrassed, frustrated, or nervous. These situations are usually not signs of trichotillomania (hair-pulling disorder). 

Trichotillomania can be quite rare. It’s sometimes referred to as “hair-pulling disorder” and has traditionally been classified as an impulse-control disorder. The American Psychological Association defines impulse-control disorders as those “characterized by a failure to resist impulses, drives, or temptations to commit acts that are harmful to oneself or to others.” Other examples of impulse-control disorders can include kleptomania, intermittent explosive disorder, and pyromania, among others.  

However, trichotillomania is increasingly being listed as a form of obsessive-compulsive disorder (OCD) and is believed to be related to anxiety disorders. OCD disorders can include several mental health disorders that typically revolve around repeated thoughts or activities. 

Neuroimaging studies have found that trichotillomania may be connected to certain aspects of the brain, such as the thickening of the right inferior frontal gyrus.

Meanwhile, neurochemical studies have found a potential relationship between the condition and the serotonin 2A receptor.

Though many people may think of hair-pulling as being related to the hair on the scalp, those with this disorder may pull hair from any part of the body. However, this tends to most commonly be on the scalp, eyelids, or eyebrows, but it’s also been seen with pulling pubic hair. With less than 2% of adults and adolescents living with the disorder, it’s generally not a very common occurrence, which can be why many have never heard of it.

Trichotillomania, according to the TLC Foundation for Body-Focused Repetitive Behaviors

According to the Trichotillomania Learning Center, or the TLC Foundation for Body-Focused Repetitive Behaviors, trichotillomania is a rare disorder characterized by the repeated pulling out one’s hair. Other mental health conditions related to body-focused repetitive behaviors might include skin conditions like skin picking, nail biting. 

Symptoms of trichotillomania

Someone with this disorder may have several symptoms that you can look for, but this disorder tends to be a very secretive one. Most who live with trichotillomania try to hide their behaviors when engaging in their social life, including hair loss and any additional activities they engage in with the hair they pull out.


The most important aspect of this disorder may be that the individual is likely pulling hair follicles out to the extent that it can cause noticeable hair loss or bald patches. They may attempt to cover this hair loss in various ways. Changing their hairstyle, wearing hats, or even using wigs may be just a few of the ways they may try to conceal their hair loss. They may also wear false eyelashes if the behavior isn’t centered on hair on the scalp.

An individual with trichotillomania usually feels a sense of tension before they engage in hair-pulling or if they are attempting to resist pulling their hair. In contrast, they usually feel gratification or pleasure when they engage in the activity. 

Many try to avoid the behavior, knowing that it can be unusual or that it may not be good for them. They may try to cut down on the number of times they engage in the activity or attempt to stop it altogether, but hair-pulling can be a type of obsessive-compulsive disorder, and it can be difficult to resist a compulsion.

Those who engage in hair-pulling may feel distressed or impaired because of it. It may seem as if they have no control, or they may start to experience shame or embarrassment due to the disorder. This can affect their abilities when it comes to work, school, and personal aspects of their lives, as they may try to avoid situations where someone might find out about the disorder. The resulting stress and strain may also lead to negative side effects.

Finally, someone with trichotillomania may engage in other behaviors that revolve around the hair they pull out. They may play with or examine the hair, chew or eat it, or engage in other habits. Individuals who eat their hair may experience additional harmful symptoms such as developing large, matted hairballs in their digestive tracts. 

It can be important to watch for these behaviors and help the individual who is experiencing symptoms seek treatment. Though it may not seem like a serious disorder or problem, pulling hair out can be unhealthy, and those living with trichotillomania deserve proper support.

When does trichotillomania start?

For most, trichotillomania tends to appear between the ages of nine and 13, although it can develop at other ages in some people. It can be more common among those who may have experienced difficult emotional states, boredom, or anxiety, as well as those who have a history of abuse* or other trauma in their lives or family histories. In addition, trichotillomania can contribute to other challenges.

Because trichotillomania normally involves pulling hair out, it can be noticed by others, and it often comes with a stigma. Someone who lives with this disorder may be likely to feel shame or guilt due to the hair pulling. In situations where entire of patches of hair are pulled out, it can be especially stressful as it becomes noticeable, and it may result in teasing. This can lead to even more trauma from the disorder and may contribute to additional developmental concerns. The younger the individual, and the more sensitive they may be, the more important it can be to seek treatment quickly.

Because trichotillomania can fall under the obsessive-compulsive umbrella, other OCD-related symptoms may be present at the same time. Individuals who live with this disorder may experience counting, washing, or other compulsive behaviors, which can interfere with day-to-day life. Depression and anxiety can also be common alongside trichotillomania.

Treatment of trichotillomania and obsessive-compulsive disorder

Do you experience compulsive hair-pulling?

Trichotillomania treatments are similar to those related to other forms of impulse control disorders and obsessive-compulsive disorder. Some home options might include deep breathing or using a stress ball when you feel the urge to pull out your hair. These options can help soothe the emotional distress that leads to an increasing sense of urgency to engage in hair pulling behavior. 

If you or someone you know may be living with this disorder, it can be best to seek professional mental health treatment as soon as possible. It may seem like something you can overcome on your own, but you may find that moving past trichotillomania can be easier with support.

Psychotherapy with a licensed mental health professional can be an excellent place to start. There may be several types of therapy used to help people with trichotillomania overcome their urges. One of the most common therapy methods for this condition is generally called habit reversal training (HRT), which can help you identify situations in which you’re most tempted to pull your hair, and then learn other ways to respond to that urge. 

A second type of therapy – acceptance and commitment therapy (ACT) – can also be used, and it typically teaches individuals how to accept the urges to pull hair without acting on them. 

Research has shown that combining HRT and ACT can be particularly effective in decreasing hair-pulling, as well as alleviating depression and anxiety symptoms. You can complete these types of therapy in person or online.

Benefits of online therapy 

An online therapy platform can make it simple to find a licensed mental health professional with experience working with people who have trichotillomania, as well as therapists who use principles of habit reversal training and acceptance and commitment therapy. With BetterHelp, you can meet with a licensed therapist via video, phone call, or online chat, and these options may help you feel more comfortable opening up about a potentially vulnerable topic.

A 2022 feasibility trial looked into the potential efficacy of online acceptance-based behavior therapy for trichotillomania and skin-picking disorder. It found that the majority of participants were satisfied with the treatment, and significant decreases in hair-pulling and skin-picking severity were demonstrated and maintained at the 12-month follow-up point. If you’re living with trichotillomania or a similar disorder, online therapy may be a valid treatment option for you.


Trichotillomania can be viewed as a rare condition that generally leads people to pull out their hair, whether from their head or other parts of their body. It is typically considered a form of obsessive-compulsive disorder (OCD) and can be best treated with the help of a licensed therapist using acceptance and commitment therapy and habit reversal training. Many people with trichotillomania try to hide their condition, but there’s no shame in reaching out for help, whether in person or online.
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