Trichotillomania, also called hair-pulling disorder, is a condition in which a person repeatedly pulls out their own hair. The pulling most commonly targets the scalp, but it can also involve the eyebrows, eyelashes, beard, and hair on the arms, legs, or pubic area. Over time, this behavior leads to noticeable hair loss, which may appear as bald patches, thinning areas, or shortened and broken hairs.

The core symptoms of trichotillomania include:

• Recurrent, compulsive hair pulling that results in hair loss
• Repeated attempts to decrease or stop the pulling, with limited success
• Significant distress or impairment in social, occupational, or other important areas of functioning caused by the behavior

Hair pulling may occur in two distinct styles. Focused pulling happens deliberately, often in response to a rising sense of tension or an urge that is temporarily relieved by the act of pulling. Automatic pulling happens outside conscious awareness, typically during sedentary activities like reading, watching television, or talking on the phone. Many people experience both styles.

After pulling, some individuals engage in oral behaviors such as running the hair across their lips, biting the root bulb, or chewing and swallowing the hair. Swallowing hair (trichophagia) can, in rare cases, lead to a hairball (trichobezoar) in the gastrointestinal tract, which may require medical attention.

People with trichotillomania frequently experience shame, embarrassment, and a sense of being out of control. They may go to great lengths to conceal their hair loss by wearing hats, scarves, wigs, or heavy makeup, and they may avoid social situations, intimate relationships, medical appointments, and activities like swimming where hair loss could be exposed.

Trichotillomania is classified in the DSM-5 under Obsessive-Compulsive and Related Disorders. To receive a formal diagnosis, a person must demonstrate recurrent hair pulling that leads to hair loss, repeated efforts to stop or reduce the behavior, and clinically significant distress or impairment. The hair loss must not be better explained by another medical condition, and the pulling must not be attributable to another mental disorder.

Diagnosis is typically made through a clinical interview. A mental health professional will ask about the history and pattern of pulling, triggers, the amount of time spent on the behavior, prior attempts to stop, and the degree to which the behavior affects daily life. Standardized instruments such as the Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale can be used to quantify symptom severity.

The condition often begins around puberty, between the ages of 10 and 13, and it affects an estimated 1% to 2% of the general population. It is more commonly reported in females than males, though this may partly reflect differences in help-seeking behavior and the visibility of hair loss.

Cognitive-behavioral therapy (CBT) is the most well-supported treatment for trichotillomania. A specific form of CBT called habit reversal training (HRT) is considered the first-line intervention. HRT involves three core components: awareness training, in which the person learns to identify the situations, emotions, and sensory cues that precede pulling; competing response training, in which the person practices a physically incompatible behavior (such as making a fist) whenever an urge arises; and social support, in which a trusted person provides encouragement and reinforcement.

Other evidence-based behavioral strategies include stimulus control techniques (modifying the environment to reduce pulling opportunities), acceptance and commitment therapy (ACT), and comprehensive behavioral treatment (ComB), which integrates sensory, cognitive, affective, motor, and environmental interventions. Many individuals benefit from a combination of these approaches tailored to their specific pulling patterns and triggers.

If you are pulling out your hair and finding it difficult to stop, or if hair pulling is causing you distress, embarrassment, or problems in your relationships, work, or daily life, it is a good idea to seek professional help. Trichotillomania does not typically resolve on its own, and without treatment, it tends to follow a chronic course with periods of waxing and waning severity.

You should seek help sooner rather than later if:

• You have noticeable bald patches or thinning that you feel compelled to conceal
• You have tried repeatedly to stop pulling but cannot
• You are avoiding social situations or experiences because of your hair loss
• You are chewing or swallowing pulled hair
• You feel significant shame, anxiety, or depression related to the behavior
• The hair pulling is consuming a large amount of your time

A mental health professional with experience treating body-focused repetitive behaviors (BFRBs) is the best person to consult. The TLC Foundation for Body-Focused Repetitive Behaviors maintains a directory of trained clinicians. Many therapists now offer teletherapy sessions, which can make specialized care accessible regardless of location.

Trichotillomania is more common than many people realize, and effective treatments are available. Reaching out for support is a sign of strength, not weakness.

For more information, visit these trusted resources:

• National Institute of Mental Health (NIMH)
• NHS: Trichotillomania (Hair Pulling Disorder)
• TLC Foundation for Body-Focused Repetitive Behaviors