thoughtscape NP Psychiatry · Understanding mental health
Trichotillomania (Hair-Pulling Disorder)
Hair pulling may be automatic, urge-driven, or both. Treatment focuses on the pattern and the situations that keep it going.
What is trichotillomania?
Trichotillomania involves repeatedly pulling out hair, repeated efforts to reduce or stop, and distress or interference with daily life. Hair may be pulled from the scalp, eyebrows, eyelashes, or other areas.
It belongs to a group called body-focused repetitive behaviors. Some pulling happens with little awareness, such as while reading. At other times, a person feels a strong urge or searches for a hair that feels different.
What difficulties may it cause?
Hair loss, skin irritation, soreness, and efforts to conceal affected areas may take up substantial time. Shame may lead someone to avoid haircuts, swimming, photographs, or closeness with other people.
People may feel relief or satisfaction during pulling and frustration afterward. A person can want to stop and still find the behavior difficult to interrupt. Criticism or reminders to “just stop” rarely address the process.
What tends to trigger pulling?
Common triggers: Triggers vary. They may include stress, boredom, concentration, certain textures, or a familiar hand movement. Not every episode follows anxiety, and pulling may continue even when someone feels relatively calm.
Assessment should also consider skin or hair conditions and other reasons for hair removal. Hair pulling done to correct a perceived appearance flaw may require a different treatment focus.
How is it assessed?
Understanding the pulling pattern: Your provider asks where pulling occurs, when it happens, what you notice beforehand, and what you have tried. The effect on your skin, hair, routines, and relationships matters. Photos or a brief record may help if you are comfortable using them.
Swallowing hair: Tell your provider if you swallow hair. Swallowed hair may form a mass in the digestive tract. Abdominal pain, vomiting, or difficulty eating needs medical assessment.
What treatment helps?
Habit reversal training: Behavioral treatment, especially habit reversal training, is a central approach. It builds awareness of the movement or urge, introduces a competing response, and changes situations that make pulling easier. A broader behavioral plan may address sensory needs, emotions, and the environment.
Medication and supplements: Medication may be considered for some people or for another condition occurring alongside pulling. Evidence differs by medication, and there is no single reliably effective medication approach for everyone. Discuss supplements with your provider rather than starting them on your own.
Making the plan practical
A plan for one setting: Identify one common setting, such as reading in bed or working at a computer. Your therapist can help you choose a realistic hand activity, barrier, or environmental change for that setting. A useful plan should fit the reason pulling happens, not simply add another rule to follow.
Track small changes in awareness and recovery after an episode. A return of pulling is information to use in treatment.
Ask: Do you treat body-focused repetitive behaviors? What should I practice first? Does the affected skin need medical care?
About this information
Educational handout; does not replace your prescription or your provider’s recommendations.