What is Trichtillomania
Trichotillomania, also known as hair-pulling disorder, is a mental health condition that involves recurrent, irresistible urges to pull out hair from the scalp, eyebrows, eyelashes or other parts of the body.
For many people, this behavior isn’t simply a bad habit or a reaction to stress. It’s a complex condition that can cause emotional distress, visible hair loss and feelings of shame, isolation or anxiety. Trichotillomania is classified as a body-focused repetitive behavior (BFRB) and is part of the Obsessive-Compulsive and Related Disorders category in the DSM-5.
While it may not be widely discussed, it affects millions of people and deserves compassionate, informed support.
What Does Trichotillomania Look Like?
People with trichotillomania may pull hair from:
- Scalp
- Eyebrows
- Eyelashes
- Beard or facial hair
- Arms, legs or pubic area
Hair-pulling may be automatic, meaning the person doesn’t even notice they’re doing it, or focused, where the urge is deliberate and conscious. Some people pull when they’re bored, stressed, anxious or tired. Others pull as part of a sensory ritual, such as examining or playing with the hair after pulling it.
The behavior often leads to bald patches, skin irritation and social withdrawal.
Who Is Affected?
Trichotillomania typically begins in late childhood or adolescence, with the average onset between ages 10 and 13. It affects people of all genders but is more commonly reported among females.
According to the TLC Foundation for Body-Focused Repetitive Behaviors, about 1 in 50 people will experience trichotillomania in their lifetime. It often co-occurs with other mental health conditions, such as:
- Anxiety disorders
- Depression
- Obsessive-compulsive disorder (OCD)
- Attention deficit hyperactivity disorder (ADHD)
- Skin picking disorder (excoriation)
What Causes Trichotillomania?
There’s no single known cause of trichotillomania. Instead, it likely results from a combination of biological, psychological and environmental factors.
Possible contributing elements include:
- Brain chemistry. Imbalances in serotonin, dopamine or glutamate may play a role.
- Genetics. Having a close relative with OCD or trichotillomania may increase risk.
- Stress or trauma. For some, hair-pulling begins during stressful or traumatic events.
- Emotional regulation challenges. Hair-pulling may serve as a way to cope with uncomfortable feelings or tension.
Importantly, trichotillomania isn’t a choice or a flaw in willpower. It’s a recognized medical condition that can be addressed with appropriate care.
How Is Trichotillomania Diagnosed?
To be diagnosed with trichotillomania, the behavior must:
- Involve repeated pulling of your own hair, resulting in hair loss
- Include repeated attempts to stop or reduce the behavior
- Cause significant distress or impairment in daily life
- Not be better explained by another medical or psychiatric condition
A licensed mental health professional can make this diagnosis through interviews, observation and assessments. In some cases, a dermatological evaluation is also helpful to rule out skin or scalp conditions.
Treatment Options for Trichotillomania
Trichotillomania can be challenging, but it is treatable. A combination of therapy, behavioral interventions and supportive tools often works best.
Cognitive Behavioral Therapy (CBT)
CBT is one of the most effective treatments for trichotillomania, especially when it includes habit reversal training (HRT). This approach teaches individuals to:
- Recognize triggers and patterns
- Use competing responses (e.g., squeezing a stress ball instead of pulling)
- Build awareness of automatic behaviors
- Reduce negative self-talk and shame
Acceptance and Commitment Therapy (ACT)
ACT helps people tolerate uncomfortable urges and emotions without acting on them. It focuses on mindfulness, acceptance and value-based actions.
Medication
There’s no FDA-approved medication for trichotillomania, but some people benefit from:
- Selective serotonin reuptake inhibitors (SSRIs)
- N-acetyl cysteine (NAC), a supplement that affects glutamate
- Other psychiatric medications, prescribed off-label based on symptoms
Medication is often most effective when combined with therapy.
Support Tools and Community
Tools like fidget devices, mindfulness apps or wearing gloves can help interrupt the pulling cycle. Online support groups, therapy groups and organizations like the TLC Foundation for BFRBs offer education and connection.
Living With Trichotillomania
People living with trichotillomania often experience shame, secrecy and low self-esteem. Many go to great lengths to hide bald spots or scarring, which can lead to social anxiety or isolation.
Compassion is essential — both from others and from yourself. Recovery doesn’t mean never pulling again. It means reducing the behavior, improving emotional well-being and reclaiming confidence and quality of life.
If you or someone you love is struggling, know this: You’re not alone, and help is available.
Frequently Asked Questions
While trichotillomania shares features with anxiety, it’s classified under obsessive-compulsive and related disorders in the DSM-5. It often co-occurs with anxiety disorders but is its own diagnosis.
Trichotillomania is not classified as obsessive-compulsive disorder (OCD), but it is related. It’s categorized under “Obsessive-Compulsive and Related Disorders” in the DSM-5 due to its compulsive nature. While both involve repetitive behaviors, trichotillomania is considered a body-focused repetitive behavior (BFRB) and may respond to different types of treatment than OCD.
There’s no “cure,” but many people experience significant improvement with therapy, medication and lifestyle tools. Recovery is possible with support.
Trichotillomania is not typically considered intentional self-harm. While both involve repetitive behaviors that result in physical harm, hair-pulling is usually driven by sensory or emotional regulation needs, not a desire to punish yourself.
Unlike alopecia or other medical hair loss conditions, trichotillomania involves repeated manual pulling and is often accompanied by emotional distress and shame.
In some cases, childhood hair-pulling is temporary. But if the behavior persists and causes distress, early intervention can make a significant difference.
You Deserve Support Without Shame
Trichotillomania can feel confusing, frustrating or even hopeless — but it’s not your fault, and you don’t have to handle it alone. With the right care and support, people with trichotillomania can reduce their symptoms and regain control of their lives.
If you’re looking for help, the Mental Health Hotline is here to provide free, confidential support 24-7. Whether you’re seeking therapy options, just learning about the condition or feeling overwhelmed by symptoms, our team can guide you toward compassionate resources that work.
Call today. Healing starts with understanding — and understanding starts here.
