Trichotillomania (also known as hair-pulling disorder) is a mental health condition in which a person compulsively pulls out hair from their scalp, eyebrows, eyelashes, or other parts of the body.
Trichotillomania (also known as hair-pulling disorder) is a mental health condition in which a person compulsively pulls out hair from their scalp, eyebrows, eyelashes, or other parts of the body. This often leads to noticeable hair loss. While it has some similarities to obsessive-compulsive disorder (OCD), trichotillomania is actually part of a broader group of conditions known as obsessive-compulsive and related disorders.
In the long term, trichotillomania can lead to significant loss of hair, broken hairs, and, in some cases, permanent hair loss.
Like many mental health conditions, trichotillomania is often treatable with medication, therapy, or a combination of the two. Hair regrowth is also possible, especially when hair pulling behavior is reduced. Hair growth medication may help support the regrowth process.
In this condition guide, we’ll explain what trichotillomania is, its symptoms, how doctors diagnose and treat it, and more.
Trichotillomania (TTM), sometimes called “trich” for short, is a mental health disorder where an individual repeatedly and compulsively pulls out their own hair. This may include hair from the scalp, eyebrows, eyelashes, or other parts of the body
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) classifies trichotillomania in the “obsessive-compulsive and related disorders” category. This category also includes obsessive-compulsive disorder, body dysmorphic disorder, and hoarding disorder.
Trichotillomania is also part of a group of conditions known as body-focused repetitive behaviors (BFRBs). These are behavioral disorders characterized by repeated, compulsive actions directed at one’s own body. This group also includes skin-picking disorder (dermotillomania) and nail-biting disorder (onychophagia).
Estimates suggest trichotillomania impacts up to two percent of the general population.
Up to 80 percent of people with trichotillomania also experience other mental health disorders. These don't cause hair pulling directly, but they can increase emotional distress, reduce impulse control, or make the behavior harder to manage. Common co-occurring conditions include:
Obsessive-compulsive disorder (OCD) and related conditions (like skin-picking disorder or body dysmorphic disorder)
Substance use disorder
Eating disorders
If another condition in addition to trichotillomania is present, treatment may need to address both to be effective.
The main symptom of trichotillomania is repeated, difficult-to-control hair pulling. The intensity of the urge to pull hair can fluctuate.
Researchers have found that around 70 percent of people with trichotillomania pull hair from their scalp. The next most likely targets for hair pulling are the eyebrows and pubic region.
Other symptoms include:
Hair loss. This can appear as bald patches, uneven hair growth, or thinning areas.
Skin irritation. Pulling can lead to redness and soreness. Tools, like scissors or tweezers, often lead to more focused, deeper, or repetitive pulling, which increases the risk of skin damage and irritation.
Gastrointestinal (GI) issues. Up to 20 percent of people with trichotillomania eat their hair after pulling it out, a behavior known as trichophagia. In some cases, this can lead to trichobezoars (hair balls), which may cause intestinal blockages.
Trichotillomania can also affect your mental well-being and quality of life, leading to feelings of anxiety, low self-esteem, or emotional distress.
Like with many mental health disorders, experts don’t know exactly what causes trichotillomania. But research suggests that it involves a mix of biological, environmental, and psychological factors.
Factors that can contribute to the development of trichotillomania include:
Biological factors
Genetics: The condition often runs in families, suggesting a hereditary component
Brain structure and function: Neuroimaging studies show differences in areas of the brain involved in habit formation, impulse control, and emotional regulation.
Brain chemistry: Imbalances in brain chemicals like serotonin and dopamine may play a role
Psychological factors
Stress coping: Hair pulling often develops as a way to cope with anxiety, boredom, or tension
Reinforcement: The temporary relief or satisfaction that follows pulling creates a cycle that strengthens the behavior over time
Environmental and Developmental factors
Stressful or traumatic event: emotional stress or trauma, especially during childhood or adolescence, may increase susceptibility.
Age: Trichotillomania most commonly begins between ages 10 and 13, a period when emotional stress, brain development, and habit learning intersect.
While triggers are not causes, they play a key role in when and how hair pulling happens. Understanding personal triggers can help you recognize patterns and develop strategies to manage them.
Hair pulling can be automatic or focused:
Automatic hair pulling happens without a person being fully aware, often when engaged in other activities like watching TV, reading or thinking.
Focused hair pulling is more intentional and usually occurs in response to specific urges or emotions, often as a way to relieve anxiety, tension, or discomfort.
Triggers can vary from person to person, but they typically fall into one or more of the following buckets:
Sensory. Hair pulling may be prompted by the feel, texture or look of the hair, like when it reaches a certain length, or grows in a specific spot. Some people are triggered by sensations on the scalp or skin.
Emotional. Feelings like anxiety, boredom, or anger can be a trigger for hair pulling. For some, pulling becomes a way to self-soothe or regain a sense of control.
Cognitive. Recurring thoughts or urges related to appearance, position or feel of certain hairs can lead to pulling.
Trichotillomania can occur at any age and affects both men and women. But certain factors may increase the likelihood of developing the condition.
These are known as risk factors. Let’s review these now.
Age: Trichotillomania usually begins during early adolescence, most commonly between ages 10 and 13. It can also appear earlier in childhood or later in adulthood, but adolescence is the most common window for onset.
Gender: Some research suggests trichotillomania may be up to four times more common in women than in men. But the actual gender difference in the general population is thought to be smaller than this because men and boys may be less likely to seek help for hair pulling.
Family history: People with a close family member with trichotillomania are at a higher risk of developing the condition themselves, suggesting that genetics may play a role in the development of the condition
Stressful life events or trauma: Major changes like moving, starting a new school, family problems, or traumatic experiences can trigger the onset of trichotillomania, especially in people who are already vulnerable. Hair pulling often begins as a way to cope with overwhelming emotions or stress
Think you might have trichotillomania? Talking to a healthcare provider is an important first step. Hair pulling disorder is a treatable mental health condition. You don’t have to face it alone. Many people struggle with similar behaviors, and help is available.
Here’s what the diagnostic process typically looks like, and what you can expect.
Because of visible symptoms like patchy hair loss, many people first seek help from a dermatologist (a specialist in skin and hair disorders). During the visit, the dermatologist will perform a physical exam to assess the pattern and extent of the hair loss. They will also ask questions about when the hair loss started, possible triggers, and any related behaviors or emotional patterns. If it remains unclear whether there’s a medical condition causing the hair loss, they may do a small biopsy to help rule out other causes.
If they suspect trichotillomania, they will refer you to a mental health professional for further evaluation
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), trichotillomania is diagnosed when all of the following criteria are met:
Repeated hair pulling from one or more areas, causing noticeable thinning or bald patches.
Repeated attempts to stop or cut back on the behavior without success.
The behavior causes distress or impacts one or more areas of functioning in daily life.
The hair loss isn’t caused by a medical condition (e.g. alopecia areata or female pattern hair loss).
The behavior isn’t better explained by another mental health disorder.
During a clinical assessment, a mental health professional will evaluate you based on these criteria and other relevant factors to determine if you have trichotillomania and recommend appropriate treatment.
Trichotillomania is a treatable condition, but treatment often requires a combination of approaches tailored to each individual. The most effective strategies typically involve behavioral therapy, with medication sometimes used to help manage symptoms.
Let’s go over the different trichotillomania treatments now.
The most well-supported treatment for trichotillomania is cognitive behavioral therapy (CBT), particularly a technique called Habit Reversal Training (HRT).
This approach helps people become more aware of their hair-pulling patterns and teaches alternative behaviors to replace them. Treatment usually involves identifying the situations, thoughts, or feelings that trigger pulling, learning competing responses (like using the hands in another way), and developing strategies to manage stress and regulate emotions.
Other types of therapy that may be helpful, particularly when emotional regulation is an issue, include acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT).
There are currently no FDA-approved medications specifically for the treatment of trichotillomania. However, there are medications available that can help manage symptoms, particularly in people with co-occurring conditions like anxiety or depression.
Medications used in the treatment of trichotillomania include:
Clomipramine, a tricyclic antidepressant (TCA)
Olanzapine, an antipsychotic medication
N-acetylcysteine (NAC), an over-the-counter supplement with limited but promising research
Medication is usually most effective when combined with therapy, rather than use on its own. Your healthcare provider will work with you to create a treatment plan based on your specific needs and symptoms.
Can you reverse hair loss from trichotillomania? Sometimes, yes! But it depends on how long the pulling has been happening and if the hair follicles are still active.
Minoxidil may help with regrowth.
If the hair follicles are too damaged, regrowth might not be possible. In that case, you can try wigs, hair pieces, or style hair around areas where you have hair loss.
The best next step? See a dermatologist. They specialize in skin, hair, and nails. And they can guide you through the right treatment plan for your needs.
There is no known way to prevent trichotillomania. The condition often begins during childhood or adolescence and appears to develop from a combination of genetic, neurological, and psychological factors — many of which are outside a person's control.
But, recognizing early signs and getting timely support may help reduce the impact of the disorder or lead to earlier diagnosis and treatment.
Some approaches to consider:
Learn to manage stress: When you understand how to handle stress, you’re less likely to rely on habits like hair pulling to find relief.
Catch it early: Noticing the urge to pull? The sooner you recognize the signs of body-focused repetitive behaviors, the easier it will be to get support and address the condition.
Treat other conditions: Anxiety, depression, and other mental health challenges can play a role in hair pulling. Getting help for other mental health conditions can make it easier to manage trich.
Trichotillomania affects more than just your hair — it can impact your confidence, social life, and mental health. But it’s treatable!
If you think you might have trichotillomania, talk to a mental health professional. They can help you understand your symptoms and guide you toward recovery.
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