What Is Trichotillomania (Hair Pulling Disorder)?

Trichotillomania — pronounced trick-oh-till-oh-MAY-nee-ah, and often called "trich" — is a body-focused repetitive behavior (BFRB) characterized by the compulsive urge to pull out hair from the scalp, eyebrows, eyelashes, or other areas of the body. Hair pulling often results in noticeable hair loss, bald patches, or thinning — which many people go to significant lengths to conceal.

Trichotillomania is classified as an obsessive-compulsive and related disorder in the DSM-5, though it differs from OCD in important ways. The pulling is often driven by sensory urges, tension relief, or habit rather than intrusive thoughts — and it can happen automatically, almost without awareness.

Trichotillomania typically begins in late childhood or early adolescence, often around puberty. It affects people of all genders, though by adulthood the majority of reported cases are in women. It frequently co-occurs with skin picking disorder, nail biting, and other BFRBs — as well as anxiety and depression.

Automatic vs. Focused Pulling

Not all trichotillomania looks the same. Two distinct pulling styles are commonly identified:

Many people experience both styles at different times. The pulling location can also vary — scalp, eyebrows, eyelashes, body hair — and may shift over time.

Common Trichotillomania Symptoms

Trichotillomania symptoms go beyond the pulling itself. The condition involves a cycle of urges, behavior, and emotional consequences that can significantly impact daily life and relationships.

• Recurrent urges to pull hair from the scalp, eyebrows, eyelashes, or other areas
• Noticeable hair loss, thinning, or bald patches
• Pulling hair without being fully aware it's happening
• Tension or discomfort before pulling that is relieved by the act of pulling
• A sense of satisfaction, pleasure, or relief during or immediately after pulling
• Shame, guilt, or embarrassment about the pulling and its results
• Concealing hair loss with hairstyles, hats, scarves, wigs, or makeup
• Avoiding situations — swimming, wind, intimacy — where hair loss might be noticed
• Playing with pulled hair afterward — examining the root, running it through the fingers, or in some cases, eating it
• Repeated attempts to stop or reduce pulling that haven't fully succeeded

Why Does Trichotillomania Happen?

The exact cause of trichotillomania is not fully understood. Research points to a combination of genetic, neurological, and environmental factors. BFRBs tend to run in families, suggesting a genetic component. They frequently begin during periods of stress or significant transition — puberty being the most common onset point.

For many people with trichotillomania, pulling serves a self-regulation function — it reduces tension, provides sensory stimulation, or offers a way to cope with difficult emotions like anxiety, boredom, frustration, or overstimulation. This is not a conscious choice. The behavior becomes automatic over time, reinforced by the relief it provides.

How Is Trichotillomania Treated?

Trichotillomania is treatable. The most evidence-supported treatments fall under the umbrella of cognitive behavioral therapy (CBT) and include:

• Habit Reversal Training (HRT) — The most researched treatment for trichotillomania. HRT involves building awareness of pulling triggers, urges, and behaviors, then practicing a competing response — a physical action that makes pulling impossible — whenever the urge arises.
• Comprehensive Behavioral Treatment (ComB) — A more individualized approach that identifies the specific sensory, cognitive, emotional, and situational factors driving each person's pulling — and tailors interventions to those specific drivers.
• Acceptance and Commitment Therapy (ACT) — Helps people develop a different relationship with pulling urges — learning to notice and accept urges without necessarily acting on them, while staying committed to valued living.

Medication has not been found to be a reliable standalone treatment for trichotillomania, though some medications may help with co-occurring anxiety or depression. Supplements like N-acetylcysteine (NAC) have shown some promise in research but are not a replacement for behavioral treatment.

What Does This Trichotillomania Test Measure?

This free hair pulling screening was created by Nathan Peterson, LCSW — a licensed therapist specializing in OCD, anxiety, and body-focused repetitive behaviors. The test assesses the presence and severity of trichotillomania symptoms including pulling urges, frequency, hair loss, emotional impact, and daily functioning.

This is not a clinical diagnosis. Only a licensed mental health professional can formally diagnose trichotillomania. But it gives you a clear picture of whether what you're experiencing matches the pattern of hair pulling disorder — and how significant your symptoms appear to be.

Frequently Asked Questions About Trichotillomania