Hair Pulling Test: Do I Have Trichotillomania?

Trichotillomania, said trick-oh-till-oh-MAY-nee-ah and usually shortened to trich, is pulling out your own hair. That can be from your scalp, eyebrows, eyelashes, beard, arms, or anywhere else hair grows. It's one of the body-focused repetitive behaviors, or BFRBs, along with skin picking and nail biting, and the DSM-5 lists it near OCD.

It doesn't work the same way OCD does, 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 pulling going, whether or not you can name what set it off.

It usually starts in late childhood or the early teen years, and it tends to come in waves, with quiet months and then a stretch where it takes over. Anxiety, depression, and other BFRBs often show up alongside it.

Trich doesn't look the same on everyone. Two patterns come up over and over, and it's common to have both depending on the day.

Which style you're in matters for treatment. Automatic pulling needs awareness work first, because you can't interrupt something you don't notice. Focused pulling needs you to sit with the urge and not go looking.

The pulling is the part people see. A lot of the weight is in the urges and in everything you do to hide it.

• Urges to pull from your scalp, brows, lashes, or body that build until you do it
• Thinning, a bare patch, a gap in a brow, or missing lashes
• Finding hair on your hands or clothes and not knowing when it happened
• Tension before you pull that drops the second you do
• A rush of satisfaction during the pull, then guilt soon after
• Hats, scarves, a certain part, makeup, wigs, or false lashes doing cover work
• Skipping the pool, windy days, the hairdresser, or being close to someone in good light
• Playing with the hair afterward, checking the root, or running it across your lips
• Rules you set for yourself that last a week, and then you're back where you started

There's no single cause. BFRBs run in families, which points to genetics, and pulling often starts during a stretch of stress or change. From there the behavior teaches itself, because the relief is fast and reliable.

Pulling is usually doing a job for you. It might take the edge off tension, or give your hands something to do when you're bored. That's why it tends to show up at the end of the day, in front of a mirror, on your phone, or during work you're avoiding.

Trich is treatable, and the work is behavioral. The approaches with the most research behind them:

• Habit reversal training. The most studied option. You learn to catch the urge or the first movement, then use a competing response, something your hands do instead that makes pulling awkward, until the urge passes.
• The ComB model. You map your own pulling, including the sensations, the setting, the thoughts, and the mood, and then change the specific pieces that feed it. That might mean covering the mirror, changing the lighting, or keeping something textured in your pocket.
• Acceptance and commitment therapy. You practice letting an urge be there without acting on it. The urge is uncomfortable, and it isn't an instruction.

Medication hasn't held up as a treatment for pulling on its own, though it can help with anxiety or depression that come along with it. N-acetylcysteine, a supplement usually shortened to NAC, has some research behind it with mixed results, and it doesn't replace the behavioral work. Talk to a prescriber before you start anything.

I'm Nathan Peterson, LCSW, a licensed therapist who works with OCD, anxiety, and BFRBs, and I wrote this free screening. It looks at four things: the urges, how often you pull and how much hair is going, the hiding and shame, and how much of your life the pulling is shaping.

It isn't a diagnosis. Only a licensed professional can give you that. What it can do is show you whether what you're dealing with fits the pattern of hair pulling disorder, and how heavy it's gotten, so you know what kind of help to look for.