What Is Trichotillomania And How Does It Affect You?

Updated February 20, 2023by BetterHelp Editorial Team

Hair Pulling Is A Serious Disorder But There Is Help

If you’ve not heard of trichotillomania, you’re not alone. But for those who live with it, trichotillomania is a serious disorder that can be difficult to overcome or even explain to others. In simple terms, trichotillomania is hair pulling – but it’s more complicated than it may sound. For those with this disorder, it's an impulse they feel they can't control that causes them to pull on their hair to get relief. 

What Is Trichotillomania?

You may have a sibling that tugged on your hair as a sign of affection or teasing, or you may be someone who twists their hair when frustrated or nervous. These things are not signs of trichotillomania, at least, not on their own. 

Considered rare, trichotillomania – sometimes referred to as trich or as hair-pulling disorder– has traditionally been classified as an impulse control disorder. The American Psychological Association defines impulse control disorders as “a disorder 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 orders include things like 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 include a number of mental health disorders that revolve around repeated thoughts or activities. Neuroimaging studies have found that trichotillomania may connected to certain aspects of the brain (i.e., thickening of the right inferior frontal gyrus) and neurochemical studies have found a relationship between the condition and the serotonin 2A receptor.

Though most people 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 – though it's generally on the scalp, eyelids, or eyebrows. With less than 2% of adults or adolescents living with the disorder, it's not a common occurrence, which is why many have never even heard of it and may not until we or someone we know experiences it. 

Symptoms Of Trichotillomania

Someone with this disorder will have several symptoms that you can look for, but keep in mind that this disorder is a very secretive one. Most who live with trichotillomania will try to hide their behaviors, including hair loss and any additional behaviors they engage in with the hair that they pull out.

Hair Pulling Is A Serious Disorder But There Is Help

The first and most important aspect of this disorder is that the individual is pulling hair out to the extent that it is causing noticeable hair loss. Of course, they may attempt to cover this hair loss in different ways. Changing their hairstyle, wearing hats, or even using wigs are just some of the ways they may try to hide their problem. It may take some time for you to notice that they have hair loss, or you may not realize it at all. That's why it's important to look at some of the other symptoms that go along with the trichotillomania as well.

An individual with trichotillomania will usually feel a sense of tension before they engage in hair pulling or if they are attempting to resist pulling their hair. In contrast, they will feel gratification or pleasure when they engage in the activity. Many will even try to avoid the behavior, knowing that it is unusual or that it's not good for them. They may try to cut down on the number of times that they engage in the activity or attempt to stop it altogether, but hair pulling is an impulse disorder, and it's difficult to take control of the impulse.

An individual who engages in hair pulling will also likely feel distressed or impaired because of the action. They may feel like they have no control, or they may start to feel shame or embarrassment because of the disorder. This can affect their abilities when it comes to work, school, or personal aspects of their life as they try to avoid situations where someone might find out about the disorder. The resulting stress and strain may also cause negative side effects in the way of their personal or professional lives as well.

Finally, someone with this trichotillomania may engage in other behaviors that revolve around the hair. That may play with or examine that hair, chew or eat it, or come up with other uncommon habits related to the hair that they pull out.

It is important to watch for any of these behaviors and to help the individual who is experiencing symptoms seek treatment as quickly as possible to work through it. Though it may not seem like a serious disorder or problem, pulling hair out  is unhealthy, and that's why it's important to help anyone who's experiencing this disorder.

When Does It Start?

For most, trichotillomania tends to appear between the ages of nine and 13, though it can happen in earlier or younger years. Because of the type of disorder and the fact that it's considered an impulse control disorder, it's more common among those who may have experienced difficult emotional states, boredom, or anxiety, or even those who have a history of abuse or other trauma in their life or family history. And unfortunately, because of the type of disorder that it is, trichotillomania can result in even more problems for those living with the mental health condition.

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

Because trichotillomania falls 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 impulsive behaviors, which can interfere with day-to-day life as well. On top of that, depression and repetitive behaviors are also common alongside trichotillomania, which can all interfere with professional and personal life and make it even more important to get help with treatment.

Seeking Treatment For Trichotillomania

If you or someone you know has the disorder, seeking treatment right away is best. It may seem like something that you can overcome by yourself, but remember, this is an impulse control or obsessive-compulsive type of disorder and it can be more difficult to overcome than you might expect it to be – especially on your own.

Psychotherapy with a mental health professional is a good place to start. There are several types of therapy used to help people with trichotillomania overcome their urges. One of the most common therapy method for this condition is called habit reversal training (HRT), which helps you identify situations where you’re most tempted to pull your hair then learn other ways to respond to that urge. A second type of therapy – acceptance and commitment therapy (ACT) – is also used and teaches patients how to accept the urges to pull hair without actually acting on them. One study of hair-pulling disorder patients found that a combination of HRT and ACT treatments resulted in an 88.87% reduction in hair pulling. A second study using HRC and ACT together found a “significant reduction” in the severity of hair pulling and both anxiety and depression symptoms that were maintained at the three-month follow-up. 

Because the hair-pulling behavior also has an emotional aspect, cognitive behavior therapy (CBT) is also commonly used to help patients identify false ideas and beliefs, then learn how to replace them with healthier responses. With BetterHelp, you can meet with a licensed therapist using video, phone call, or online chat at a time that works best for you. 

Your therapist may refer you to speak with your doctor or a psychiatrist about medications that may be helpful with treatment of symptoms. There are multiple options available. Medication combined with therapy in treatment of trichotillomania can be very helpful, but medication isn't necessary for you to begin therapy.


Trichotillomania is a rare but diagnosable condition that leads people to pull out their hair, whether from their head or other parts of their body. It is considered a form of obsessive-compulsive disorder (OCD) and is best treated with the help of a professional therapist who understands the mental illness and how to treat it. Many people with trich try to hide their condition because they are embarrassed. However, there’s no shame in getting help. You can overcome your hair-pulling impulses. 

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