Free screening · Nathan Peterson, LCSW
Hair Pulling Test: Do I Have Trichotillomania?
Trichotillomania is the pulling out of your own hair, from the scalp, the eyebrows, the lashes, anywhere it grows. Sometimes you catch yourself halfway through. Sometimes you go looking for the one hair that feels wrong. Either way the urge is real and telling yourself to stop has not worked. This free screening, written by a licensed therapist, helps you see whether what you are doing fits the pattern of hair pulling disorder and how far it has gone.
- Urges you cannot sit through
- Pulling on autopilot
- Thin patches or missing lashes
- Hiding it with hats and hair
- Relief, then shame
- Promising yourself today is the last time
How high is my urge to pick my skin?
No urge
Low urge
Moderate urge
High urge
How often do I feel the need or urge to pick my skin?
Never
Some of the time
Most of the time
All of the time
How well am I at resisting the urge to pick my skin?
Never
Some of the time
Most of the time
All of the time
How often do I find myself picking when I don’t want to?
Never
Some of the time
Most of the time
All of the time
How much time do I spend picking every day?
None
A few minutes
About 1 hour
More than 1 hour
I feel anxious, guilty, and ashamed by my skin picking.
Never
Some of the time
Most of the time
All of the time
I have caused some damage due to my skin picking. (sores, gashes, infections, etc)
None
Some damage
Moderate damage
Extreme damage
I avoid activities because of my skin picking. (seeing friends, social events, etc)
None
Some of the time
Most of the time
All of the time
My skin picking affects my daily functioning. (work, home, with friends, etc)
Not at all
Some of the time
Most of the time
All of the time
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This test does not replace an evaluation by a qualified mental health professional. A licensed therapist built it from clinical experience. See a specialist for an official diagnosis before making medical or mental health decisions. By submitting your information, you consent to receive email from OCD and Anxiety Online.
What trichotillomania is
Hair pulling disorder, in plain terms
Trichotillomania, said trick oh till oh MAY nee ah and usually shortened to trich, is pulling out your own hair. Scalp, eyebrows, eyelashes, beard, arms, anywhere. It is grouped with the body focused repetitive behaviors, or BFRBs, alongside skin picking and nail biting, and the DSM-5 files it near OCD.
The mechanics are not the same as OCD, though. OCD runs on an intrusive thought and a compulsion that tries to answer it. Trich runs on an urge in your body. Something builds, your hand finds the spot, pulling releases it, and for a few seconds you feel better. That release is what keeps the behavior going, whether or not you can name what set it off.
It usually starts in late childhood or early adolescence, often around puberty, and it tends to run in waves. Quiet months, then a stretch where it takes over. Anxiety, depression, and other BFRBs often sit alongside it.
Two styles
Automatic pulling and focused pulling
Trich does not look the same on everyone. Two patterns come up over and over, and plenty of people have both depending on the day.
Which style you are in matters for treatment. Automatic pulling needs awareness work before anything else, because you cannot interrupt something you do not notice. Focused pulling needs you to sit with the urge and not go looking.
Symptoms
What trich looks like day to day
The pulling is the part people see. Most of the load is in the urges, the hiding, and the cleanup afterward.
- Urges to pull from the scalp, brows, lashes, or body that build until you do it
- Thinning, a bare patch, a gap in a brow, lashes that are gone
- Finding hair on your hands or your clothes and not knowing when that happened
- Tension before you pull that drops the second you do
- A rush of satisfaction during the pull, then guilt within the hour
- Hats, scarves, a specific part, powder, wigs, false lashes, all doing cover work
- Skipping the pool, the wind, the hairdresser, or being close to someone in good light
- Playing with the hair afterward, checking the root, running it across your lips
- Rules you set for yourself that last a week, then the same starting point again
Why it happens
Where the urge comes from
Nobody can hand you a single cause. BFRBs cluster in families, which points at genetics, and the first stretch of pulling often starts during a period of stress or change. From there the behavior teaches itself, because relief is a fast and reliable reward.
For most people pulling is doing a job. It dials down tension, or it gives your hands something to do when you are bored and understimulated, or it cuts through overwhelm. That is why it shows up at the end of the day, in front of a mirror, on the phone, and during work you are avoiding.
Treatment
What actually helps
Trich is treatable, and the work is behavioral. The approaches with the most research behind them are:
- Habit reversal training. The most studied option. You learn to catch the urge or the early movement, then you use a competing response, something your hands do instead that makes pulling awkward, until the wave passes.
- Comprehensive behavioral treatment, or ComB. You map your own pulling, the sensory pull, the setting, the thoughts, the mood, and then you change the specific pieces that are feeding it. Cover the mirror, change the lighting, put something textured in your pocket, move where you sit.
- Acceptance and commitment therapy. You practice letting an urge be there without acting on it. The urge is uncomfortable and it is not an instruction.
Medication has not held up as a standalone treatment for pulling, though it can help with anxiety or depression sitting alongside it. N-acetylcysteine, a supplement usually shortened to NAC, has some research behind it and mixed results, and it does not replace the behavioral work. Talk to a prescriber before you start anything.
About this test
What this hair pulling test measures
This free screening was written by Nathan Peterson, LCSW, a licensed therapist who works with OCD, anxiety, and body focused repetitive behaviors. It looks at four things: the urges, how often you pull and how much hair is going, the hiding and the shame, and how much of your life the pulling is shaping.
It is not a diagnosis. Only a licensed professional can give you that. What it can do is show you whether what you are dealing with fits the pattern of hair pulling disorder and how heavy it has gotten, so you know what kind of help to ask for.
FAQ
Questions people ask
Is trichotillomania the same as OCD?
No, although they are filed in the same section of the DSM-5 and can show up in the same person. OCD is driven by an intrusive thought and a compulsion trying to make it go away. Trich is driven by a physical urge and the relief pulling gives. The treatments overlap in spirit and differ in practice, which is why it helps to work with someone who has treated BFRBs and not only OCD.
Why can I not just stop pulling?
Because the behavior pays out every single time. Pulling gives fast relief or a sensation you were after, and your brain files that away and asks for it again. Deciding to stop does not touch that loop. What does touch it is noticing the urge early and having something specific to do with your hands instead, practiced enough times that it becomes the thing you reach for.
Can trichotillomania be treated?
Yes. Habit reversal training and ComB have the most research behind them, and many people get meaningful reductions in pulling with consistent practice. The urges do not vanish in a week, and progress usually looks like fewer pulls and faster recovery after a slip rather than a clean stop. Slips are part of it, not proof it failed.
What is the difference between trich and skin picking?
They are siblings. Both are BFRBs, both run on urges and relief, both leave marks you end up covering. Trich is pulling hair. Skin picking, also called excoriation disorder, is picking at skin. They respond to the same family of treatments, and a lot of people do both, sometimes trading one for the other.
Where do people pull from?
Scalp, eyebrows, and eyelashes are the most common sites, and pulling can happen anywhere hair grows, including the beard, arms, legs, and pubic area. Sites move over time. Someone who pulled lashes at fourteen might be pulling scalp hair at thirty, and some people work two or three sites at once.
Does the hair grow back?
Usually it does, especially when a site gets a long break from pulling. Years of pulling the same spot can scar the follicle and leave regrowth patchy or permanently thinner, and that varies from person to person. A dermatologist can tell you what is going on with a specific patch. This is one of the few questions where reassurance from the internet is worth less than an actual exam.
Is it dangerous to eat pulled hair?
It can be. Eating pulled hair is called trichophagia, and hair does not break down in the gut. It can collect into a trichobezoar, a mass that causes pain, nausea, and in serious cases a blockage that needs surgery. If this is part of your pulling and you are having any stomach symptoms, see a doctor about it soon.
Do I need to stop pulling before I get help?
No, and waiting until you have it under control is how people lose years. You bring the pulling as it is, including the sites you have been hiding. There is nothing to clean up first.
Keep going
Other free places to start
Got your results. What now?
The BFRB course walks you through the same approach a session would, from catching the urge to what you do with your hands instead, so the pulling stops running your evenings.
See the BFRB course