Trichotillomania scaled
Written by: THE BALANCE
Medically reviewed by Dr. Sarah Boss, MD
Last updated: January 19, 2026
Fact checked
Quick Summary
  • Pathological or compulsive hair pulling, also known as trichotillomania, is a widespread yet underdiagnosed psychological disorder.
  • Trichotillomania is a condition in which people feel compelled to pluck their hair out.
  • Trichotillomania is a behavioral condition that causes uncontrollable temptations to pluck one's hair out.
Reading time: 14 min

Pathological or compulsive hair pulling, also known as trichotillomania, is a widespread yet underdiagnosed psychological disorder. Trichotillomania is a condition in which people feel compelled to pluck their hair out.

Trichotillomania is a behavioral condition that causes uncontrollable temptations to pluck one’s hair out. Trichotillomania affects about 1 percent of people in the US at some point in their lives. Shame and embarrassment are common side effects of this illness. When another individual learns about the condition, the embarrassment may become even worse. It’s possible that unintentionally fostering these sentiments of shame will lead to even more social isolation.

Read Also: Dermatillomania Luxury Inpatient Treatment

Many persons with trichotillomania are unaware that they have a disorder that may be diagnosed. They could just think of hair tugging as a nasty habit. Others may suffer from severe physical and mental issues. The majority of people take out their scalp hair. Some people, on the other hand, may pull hair from their eyelashes, beards, or eyebrows.

Some persons who suffer from trichotillomania eat their own hair. Trichophagia is the medical term for this disorder. It has the potential to induce serious gastrointestinal issues. Trichotillomania affects the majority of persons during their teens. Some of these persons may then battle with the disorder throughout adulthood, either continuously or occasionally.

The causes and symptoms of trichotillomania are discussed in this article, as well as the many treatment methods available.

Trichotillomania affects many people who pick their skin, chew their lips, or bite their nails. It’s possible that removing hairs off dolls or pets, as well as from fabrics like garments or blankets, is any indication. The majority of persons who suffer from trichotillomania pull their hair in solitude and try to hide the condition from others. (source: NIMH, n.d.)

Hair pulling in patients with trichotillomania can be:

Focused. Some people purposefully pull their hair out to relieve tension or anxiety, such as to gain relief from an overwhelming urge to pull hair. Some persons may develop complex hair-pulling rituals, such as searching for the perfect hair or biting pulled hairs.

Automatic. When people are bored, reading, or watching television, they may pluck their hair without even realizing it.

Based on the circumstances and attitude, the same person may do both automatic and focused hair pulling. Hair pulling can be triggered by certain positions or rituals, like laying your head on your palm or combing your hair.

Trichotillomania is linked to feelings:

Negative and Harmful Emotions. Hair pulling is a strategy for many individuals with trichotillomania to cope with negative or unpleasant feelings including stress, worry, tension, loneliness, boredom, frustration, or weariness. (source: MedlinePlus, n.d.)

Feelings of happiness.  Pulling hair out is typically pleasurable and provides some relief for people with trichotillomania. As a consequence, they continue to pluck their hair in order to retain their good mood.

Certain variables, according to doctors, can raise a person’s risk of getting trichotillomania. These are some of the risk factors:

A person with trichotillomania who has first-degree relatives (parents or siblings) with the disorder is more likely to develop it themselves.

Childhood trauma: A individual who has undergone childhood trauma is more prone to develop trichotillomania, as per the National Organization for Rare Disorders. Nevertheless, there isn’t enough evidence to back up this claim.

Altered brain function or biochemistry that could contribute to trichotillomania are also being investigated by doctors. A person’s capacity to control impulsive actions, like hair pulling, may be harmed by certain changes.

Trichotillomania is a chronic (long-term) disorder. Symptoms can change in severity over time if not treated. Menstrual hormone shifts, for instance, can exacerbate symptoms in women. Symptoms might come or go for weeks, months, or years in some people if they are not addressed. Hair pulling rarely stops within a few years of beginning. (source: APA, n.d.)

This treatment employs a number of strategies to aid in the modification of TTM-related deep-seated habits, beliefs, and feelings. It’s a customized approach that addresses five key aspects of a person’s daily life that influence their hair-pulling behavior. To remember the five modalities, the abbreviation SCAMP is coined by experts:

  • Sensory: Tactile, visual, and physical compulsions. Before and after the behavior, all five senses may be involved.
  • Cognitive: Hair-related beliefs and behaviors prior to, during, and after the behavior.
  • Affective: Feelings before, during, and after the event. They could be favorable or unfavorable.
  • Awareness/Motor Habits: The ways in which an individual’s body makes pulling hair simpler. It could be automatic, targeted, or a combination of both.
  • Place: The location, environment, social setting, activity, time of day, and numerous items that stimulate hair pulling can all be factors.

In order to find the triggers in each of the domains described above, physicians use the ComB model to conduct a complete examination and functional analysis. Sufferers start self-monitoring to identify possible target components and choose intervention options for each SCAMP modality.

Individuals have the option of selecting at least two expertise to work on over the week. They then discuss how the skills helped them. Adjustments are made, and new abilities in a different field are acquired. When people indicate that a certain skill isn’t working, the doctor and the person will look into different options from those modalities.

Management for trichotillomania or hair-pulling disorder treatment can include psychotherapy and behavioral therapy. Therapy can unearth the reasons for hair pulling and find solutions to stop the behavior based on the type of therapy and the treatment strategy of the medical professional.

Among the treatment possibilities for trichotillomania are:

Cognitive Behavioral Therapy (CBT) for trichotillomania investigates the relationship between feelings, thoughts, and behaviors that contribute to hair pulling and seek to change them. To alleviate symptoms, cognitive behavioral therapy teaches the individual to question their distorted beliefs. (source: StatPearls, 2025)

Acceptance and Commitment Therapy (ACT) for trichotillomania allows people to break the link between the desire to pull hair and the act of pulling. The idea is for the person to admit their urges while also making a commitment to stop hair pulling.

Habit Reversal Training: According to a 2012 case study, habit reversal therapy (HRT), a form of behavioral therapy, may be useful in the treatment of trichotillomania. HRT is divided into 5 stages:

  • Awareness training: The person learns to recognize the environmental and psychological elements that can lead to a hair-pulling episode.
  • Competing response training: The individual practices replacing an alternative behavior for hair pulling.
  • Motivation and compliance include engaging the individual in behaviors and activities that remind them of the need of adhering to the HRT regimen. Receiving appreciation from friends and family for success gained throughout therapy is one example.
  • Relaxation training: entails the use of techniques like deep breathing and meditation to help the person relax. These aid in the reduction of stress and the resulting hair pulling.
  • Generalization training: involves putting new skills into practice in a variety of contexts such that the newly learned behavior becomes second nature.

Most healthcare and mental health specialists think that HRT should be the first therapy choice for trichotillomania, as per a 2011 review.

Trichotillomania habit reversal training teaches individuals how to notice the sensations and thoughts that occur prior to hair pulling so that they can replace them with other activities. When emotions are running high, the therapist may suggest that the person tighten their fists or knit to prevent the temptation.

Not every therapy for trichotillomania will be effective for everyone. Trichotillomania therapy, on the other hand, can be effective with practice and patience.

When you experience the excessive need to pull your hair, here are some recommendations on how to deal with trichotillomania:

  • Squeezing a stress ball or comparable object
  • Contract or stiffen the muscles in that arm by forming a ball with your fist.
  • Make use of a fidget toy
  • Wear a headband, scarf, or a hat with a tight fit, like a beanie.
  • Make up a phrase that you repeat aloud until the temptation to pull fades away.
  • Take a relaxing bath to relieve stress and anxiety.
  • Deep breathing should be practiced until the need to pull subsides.
  • Workout and physical activity including exercise
  • Apply plasters to your fingers.
  • Shorten your hair

When your loved one is experiencing troubles and mental health challenges (in this case hair plucking), it’s normal to just want to step in and help with Trichotillomania. Nevertheless, it’s critical to know what forms of assistance are most effective. Finally, keep in mind that you (or anyone else) cannot cure your loved one’s trichotillomania, but there are methods to assist and promote change. (source: NCBI Bookshelf, 2022)

1. Help identify behavioral patterns: Observing behavioral patterns can be easier for someone in the external world to inspect and analyze another person. Being aware of the circumstances that contribute to hair pulling behaviors and the acts that accompany hair pulling can assist trichotillomania sufferers to gain clarity and understanding. Your help in recognizing trends can also aid in determining triggers and high-risk situations, which can then be avoided or dealt with more efficiently.

2. Assist in the development of coping skills and techniques to aid in the prevention of hair-pulling: Motivate your loved one to try pressing and squeezing a stress ball, pulling single threads from a piece of cloth, or fidgeting with a fidget toy as an example of a substitute habit that still offers sensory stimulation. If a person wants to duplicate or replace the feeling at the base of their hair, they may discover that using a mint shower gel, applying an icepack to the head, or combing their hair reduces the impulse to pull.

3. Adjust environmental elements as needed: For example, if hair pulling is triggered by looking in a magnifying mirror, it may be beneficial to remove the mirror entirely. If there are certain rooms in the house where pulling is most common, you might encourage your dear one to write and post written warnings to avoid such actions.

4. Promote healthy ways of expressing and coping with unpleasant emotions: Finding healthy ways to express and cope with challenging emotions may minimize the desire to pull. Keeping a journal, practicing relaxation techniques, or exercising may be beneficial to someone. These habits can also help with the symptoms of anxiety and sadness, which are common co-occurring mental health issues. While trichotillomania does not usually co-occur with anxiety or depression, many of the tactics used to treat the symptoms of these illnesses can also be utilized to treat trichotillomania.

5. Find out how you can help: This may seem like an obvious first step, but find out how your loved one would like you to assist them. It’s possible that their definition of helpfulness differs from yours. While it may appear to be beneficial to pick out pulling behaviors as they occur, this should only be conducted if requested. Otherwise, it may exacerbate feelings of humiliation. Have a talk with your beloved about how, when, and where you can best assist them.

Trichotillomania and Co-Occurring Disorders Treatment (source: Cochrane, 2021)

One of the most important aspects of trichotillomania therapy is to address all of the difficulties and disorders that a person is dealing with. Trichotillomania is frequently associated with depression and excoriation, among other mental illnesses (skin-picking disorder).

Other repeated body-focused symptoms, such as biting one’s fingernails, are common among people with trichotillomania. OCD can be diagnosed based on certain habits.

Treatment specialists must address all problems simultaneously when a patient has trichotillomania and other mental health conditions for the best results. Concentrating solely on one issue allows for the escalation of others.

Because medications for trichotillomania are ineffective, most people seek alternative treatments for relief from trichotillomania symptoms. While natural trichotillomania treatments are being researched, some options include:

N-acetylcysteine (NAC): An amino acid that aids in the regulation of mood-related substances in the brain.

Aromatherapy: It involves inhaling pleasant, relaxing, or tranquil scents to diminish the desire to pull hair, particularly when symptoms are severe. (source: ClinicalTrials.gov, n.d.)

Essential Oils: Certain people claim that essential oils can help with trichotillomania. Castor oil, rosemary oil, lavender oil, and other essential oils can be applied to the area where one pulls.

Support Groups for Trichotillomania

Trichotillomania support networks are locally available and on the internet to provide assistance, understanding, and relief to persons suffering from the illness as a supplement to specialized therapy. Participants of a support group can suggest new therapy options to help one’s condition improve.

The following are some examples of online trichotillomania support networks:

Adult Trich Support: A support group for people who suffer from trichotillomania.

Trichsters: Kids with Trich is an online support group for children and their families who have trichotillomania. (source: findtreatment.gov, n.d.)

Trichotillomania Support: A Facebook group where persons with trichotillomania can ask questions and receive feedback.

Hair Pullers Anonymous: A phone-based support group based on the 12-step Alcoholics Anonymous program.

Check out the TLC Foundation’s support group lookup tool to find trichotillomania support groups in your area.

High-ranked officials, celebrities, and athletes dealing with trichotillomania, and other behavioral compulsions, benefit greatly from premium residential and inpatient treatment. As the prevalence of stress-related trichotillomania has grown, so has the demand for therapy. Enrollment in a rehabilitation institution that focuses on mental health care is known as inpatient treatment. In addition to 5-star resort-style amenities like private rooms, spa and massage treatments, fitness centers, scenic settings, and alternative therapies like meditation, mindfulness, gourmet chef-prepared meals, yoga, and acupuncture, a high-end upscale luxury inpatient rehab center offers premium mental illness treatment.

The function of an upmarket luxury mental health inpatient treatment facility has altered dramatically since its inception. Historically, mental institutions were created exclusively to separate those suffering from mental illnesses from the rest of society, which was considered “normal.”

Clients must first rehabilitate to be able to contribute to society and, more significantly, to live a happy and independent life. A high-end residential institution offers a variety of mental health therapies to assist relieve pain and improving mental health. The following are some of them:

  • Individual and group counseling are both available.
  • Medication Administration (prescribed medications)
  • Learning to deal with and enhance your skills in order to better manage your harmful behavioral problems is essential.
  • Relapse prevention.

FAQs

Which Disorder Involves Repetitive Pulling Out Of Hair From The Head?
Trichotillomania, commonly known as a hair-pulling disorder, is a psychological disorder characterized by repeated, overwhelming urges to pluck hair from your eyebrows, head, or other parts of your body, despite your best efforts to stop.
Is It Possible To Prevent Trichotillomania?
There is currently no cure for trichotillomania. Getting medical attention and treatment as early as symptoms develop, on the other hand, may help to minimize any potential damage to a person’s mental or physical health, family, and friendships. Stress reduction may also be beneficial, as hair pulling is frequently triggered by stress.
What Are Some Of The Complications Related To Trichotillomania?
Infection, damage to the skin, and irreversible hair loss are all possible trichotillomania side effects. Skin damage and hair loss can cause body image and self-esteem issues, as well as have a negative influence on jobs and relationships. Some persons may avoid social situations in order to conceal the subsequent hair loss in extreme circumstances.
Trichophagia (eating hair) puts people in danger of developing trichobezoars, or hairballs, in their stomachs or small intestines. Trichobezoars can cause severe gastrointestinal difficulties such as pain, vomiting, nausea, bleeding, obstructions, and other complications.

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