Hair Pulling Disorder: Why Am I Pulling Hair Out, And What Are The Treatment Options?

Medically reviewed by April Justice, LICSW
Updated June 20, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

The first time you notice yourself subconsciously pulling your hair out, you might feel alarmed. Perhaps you write it off as a one-time, out-of-the-ordinary occurrence or bad habit. Many people with trichotillomania, which the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) defines as recurrent pulling of hair, will opt not to tell anyone else because they feel embarrassed. This article will attempt to alleviate some of the mystery and concern about trichotillomania and review its potential causes and possible treatment options.

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Is hair-pulling disrupting your life?

Why do I pick at my head?

Many people who struggle with hair pulling urges may do so in response to stress, anxiety, or emotional distress. When you are feeling out of control, you might subconsciously pull your hair out. 

Pulling hair is similar to the habit of nail-biting, which can become subconscious in response to stress, overthinking, or anxiety, and can be a difficult habit to break. Likewise, it can be hard to stop pulling your hair once you have developed the response. 

Hair-pulling can also be the result of an impulse control disorder or a general lack of impulse control. If you are familiar with obsessive-compulsive disorder (OCD), you might know that those who experience symptoms of this mental disorder frequently use external methods to meet the needs of OCD or another control-related challenge. For example, the individual might open and close a door a certain number of times or flick a light switch on and off a specific number of times. 

When people feel an overwhelming urge to pull out their hair, it might be considered a symptom of an impulse control disorder. While this may feel intimidating, there are solutions you can consider. First, it is important to understand the textbook definition of hair-pulling disorder, also known as trichotillomania.

What is trichotillomania?

Trichotillomania, or “hair pulling disorder,” is a mental disorder that falls in the category of obsessive-compulsive and related disorders, along with skin picking disorder, hoarding disorder, and body dysmorphic disorder. Many things can trigger trichotillomania, such as chronic stress, traumatic experiences, and other genetic and environmental factors.  

An individual who is diagnosed with trichotillomania experiences irresistible urges to pull their hair out, whether it is the hair on the individual's head, eyebrows, real or false eyelashes, arms, or pubic hair from around the genitals. Repeated attempts to stop hair pulling usually fail.  

Even when the hair becomes more resistant to pulling, an individual with this diagnosis often cannot resist the urge without assistance. The person who pulls out their hair may feel significant distress, which can prompt the urge to pull. The act of pulling out their hair usually produces positive feelings of relief from emotional distress.

In more severe cases of trichotillomania, pulling hair out causes skin and hair damage that may result in stunted hair growth and even permanent hair loss. People with trichotillomania might pull out all their eyebrow hairs or eyelashes, and eating hair is also sometimes a symptom of this mental illness. 

It’s important to recognize that trichotillomania is a separate condition from other disorders that may result in hair pulling, such as body dysmorphic disorder, in which an individual may pull out their hair due to a perceived defect with their appearance. 

How can I help my child stop picking?

Recent research on trichotillomania found that the average age of onset was 17.7 years, with significant differences by gender. If you are a parent with a child who struggles with hair-pulling and may be developing trichotillomania, there are a few things you can do to help. For example: 

  • Look For Triggers: What sets the child off? Is there a specific circumstance or scenario in which they initiate hair-pulling? Identify situations that may accompany hair-pulling in young adults.
  • Try Distractions: Once you know the trigger, you can start to practice stopping trichotillomania in its tracks. Try to develop a method to refocus energy toward something more productive or meditative. 
  • Meditation: If your child struggles with stress and anxiety, try to initiate a meditation and deep breathing practice to help prevent hair pulling.
  • Up-Dos: When possible, keep hair off the face. Braids, a ponytail, or a bun can all become a roadblock to pulling hair.
  • Physical Stress Reliever: A stress ball, fidget spinner, or any other stress-related toy can be a helpful distraction for self-inflicting or harmful behaviors such as pulling one’s hair.
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As a parent, try to be supportive. Your child is already likely stressed about the hair-pulling and might be embarrassed or upset by the response. If you can help them feel loved and supported, you might have an easier time redirecting their anxious and stressed energy and thereby treating trichotillomania.

In addition, you can reach out and ask for help. You do not need to have all the answers by yourself; it’s okay to depend on other people. Trichotillomania is one of several other mental health conditions that can develop from genetics or as a result of traumatic experiences. There are professionals who can diagnose trichotillomania and help your child receive treatment.

What are the risks of trichotillomania?

People with trichotillomania often experience gastrointestinal issues from accidentally swallowing some of the hair they have pulled out. Swallowed hair can eventually create a hairball in the individual’s digestive tract. If you have trichotillomania and experience sudden weight loss or other complications, call a doctor about the potential for serious medical conditions, such as a blockage in your digestive tract.

Additionally, a person who has trichotillomania might feel extreme discomfort in social settings. They might feel self-conscious about the areas on their head where they have noticeable bald patches in a potentially unusual shape, or they could be nervous about their behavioral response occurring in public or in their social life.

These risk factors can cause low self-esteem and impact an individual’s ability to feel comfortable in public.

Low self-esteem can be damaging to one's well-being and is associated with a range of negative outcomes, such as anxiety, depression, and poor psychological health.

Unaddressed social anxieties, especially with children, can result in more serious issues down the line. For example, a child with social anxiety might struggle with self-consciousness, which can manifest in different self-destructive or self-sabotaging behaviors. With professional assistance and personal determination, it’s possible to work toward addressing anxiety and its sources.

How to get help for hair-pulling

Getting help from a therapist can be an effective way to start learning how to control symptoms of trichotillomania and stop them before they become lifelong problems. Whether you go to online or in-person therapy, a licensed professional can help you confront your hair-pulling and set you on a path to success using a variety of therapy techniques.

One such therapy is called habit reversal therapy (HRT). This type of therapy helps you identify the trigger and replaces the urge to pull at your hair with an action that directly inhibits your ability to pull at your hair (e.g., something that uses both of your hands). 

Some psychiatrists might also prescribe selective serotonin reuptake inhibitors (SSRIs), so talk to your doctor about your options.

More research suggests that trichotillomania affects around 0.5% to 2.0% of the population, The American Psychological Association estimates that trichotillomania affects roughly 4% of the U.S. population, so if you are experiencing this disorder, you are far from alone. Support groups where you can connect with peers who are experiencing trichotillomania can be another source of healing and community. 

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Is hair-pulling disrupting your life?

Participating in online therapy can be beneficial for those struggling with trichotillomania and other kinds of mental health disorders. BetterHelp is an online counseling platform for adults, while TeenCounseling provides similar services, but for teenagers (and parents of teens). Each is designed to help you receive assistance from the comfort of your home. Since those struggling with impulse control disorders often have high levels of anxiety, making it to in-person therapy sessions might be difficult. Online therapy makes it possible to still receive care that is both convenient and comfortable. 

Recent studies also continue to prove the efficacy of online-based interventions. For instance, one such study demonstrated that an online self-help intervention was effective in reducing symptoms of trichotillomania.

Counselor reviews 

If you are still apprehensive about online therapy, check out verified user testimonials, such as this one:

“Stephanie is a blessing for the whole family. To know that my daughter has someone that she can reach out to whenever she needs is a great resource in those difficult times. I know my daughter is in good hands and I am always happy about Stephanie’s feedback and so is my daughter. I can see that the regular sessions give her stability, and the app makes it easy for her as well. The different time zones (we live across the Atlantic) are also in our favor since our daughter can reach out at night when she is thinking about her problems and get a response right away. - I can highly recommend her.” - Review written by TeenCounseling user M.A. after counseling with Stephanie Young for 5 months

Takeaway

Hair-pulling disorder can not only be difficult to manage, but it can also contribute to lowered self-esteem and impact your social life. However, with the help of a trained medical or mental health professional, you can review the common causes and symptoms of trichotillomania and seek treatment options that may be effective for you. You do not have to address this impulse control disorder on your own. An online therapist can work alongside you as you identify your triggers, learn new coping mechanisms, and take steps toward a life in which you are more in control of your happiness and health.

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