Hair-Pulling Disorder

What Is Hair-Pulling Disorder?

Hair-pulling disorder, also called trichotillomania, involves repeatedly pulling out hair, trying to reduce or stop the pulling, and experiencing significant distress or disruption. Hair loss may be visible or hidden. A diagnosis also requires checking that a medical condition or another mental health disorder does not better explain the problem.^[1]

You can ask for help without first deciding what to call it. An assessment can address pulling and its effects on your skin, hair and daily life.^[2]

Hair pulling belongs to a group called body-focused repetitive behaviors, or BFRBs. These involve repeated actions directed at the body, such as picking skin or biting nails. The name describes a pattern, not a judgment about your self-control.^[3]

Signs and Everyday Hair-Pulling Patterns

Pulling can affect the scalp, eyebrows, eyelashes or other body areas. With automatic pulling, you may not notice your hand moving while reading or watching television. With focused pulling, you deliberately respond to an urge or search for a particular hair. One person can experience both patterns.^[7]

Describe what happens rather than trying to fit a stereotype. For example, you might notice loose hairs beside your chair without remembering each pull. Or you might spend time searching for a strand that feels different, then feel frustrated when you see the damage.

In a Harvard Health Publishing article, psychologist Nancy Keuthen explains that embarrassment can affect social contact and opportunities at work. That perspective matters when preparing for care: tell the clinician what you have stopped doing or started avoiding, not only where hair is missing.^[6]

A clinician may examine the affected area and check for other causes of hair loss. They will also ask about emotions, pulling behaviors and other health concerns. Ordinary hair touching or a patch of thinning hair does not establish this diagnosis by itself.^[2]

Repeated pulling driven by an intense concern about a perceived appearance flaw may need a different assessment. The clinician should explore what the action means to you, rather than assume all pulling has the same explanation.^[1]

Why Hair Pulling May Continue

The underlying cause is not fully understood. Genetic and environmental influences may contribute. Pulling can occur during boredom or stress, or in response to uncomfortable sensations. Something that happens just before an episode is a trigger, not necessarily the cause of the disorder.^[7]

Some people experience tension before pulling and relief afterward. Others pull with little awareness. These differences help explain why simply telling yourself to stop may not address the pattern.^[3]

When writing for UT Southwestern Medical Center, psychologist Kipp Pietrantonio emphasizes describing what happens before, during and after pulling or picking. Useful details include the setting, how much time passes and the damage you notice. You can bring those observations without knowing why the behavior began.^[8]

You do not need to provoke an episode or spend the day inspecting your hair to prepare. If keeping notes becomes upsetting or takes over your attention, bring that concern to the clinician too.

Hair Regrowth, Skin Damage and Swallowed Hair

Have the physical effects checked alongside the pulling. Repeated pulling can scar or infect the skin and permanently affect hair growth. That means a universal promise about regrowth would be misleading. Ask a clinician what the affected area needs and what recovery may realistically look like for you.^[7]

Separate two questions at the appointment: “How do I care for this area?” and “How do I get help with the pulling?” You may need a medical clinician for the skin or hair problem and a therapist with experience treating the behavior.^[2]

Tell a medical clinician if you chew or swallow pulled hair. Swallowed hair can collect into a mass in the digestive tract and cause a blockage or serious illness. Do not leave this out because it feels embarrassing or because the amount seems small.^[5]

If you also pick your skin, our skin-picking disorder guide explains wound-care warning signs and questions to ask about treatment. Mention both behaviors so your care plan can address what actually happens.

How Treatment for Trichotillomania Works

Habit reversal training is a behavioral treatment that teaches you to notice pulling and use a different response. “Behavioral” means working with actions and situations in everyday life. Practice involves recognizing early signals, using a response that is incompatible with pulling, and changing circumstances that make pulling easier.^[4]

For example, a therapist might help you notice your hand moving toward your scalp, then rehearse a comfortable alternative hand position. A strategy must be practical where you need it, whether that is a classroom, a desk or the sofa. An object to hold can be part of a plan, but it is not the whole treatment.^[4]

Matching the Plan to Your Pattern

Comprehensive behavioral treatment, often called ComB, examines sensations, thoughts, feelings, movements and surroundings. In their explanation for the International OCD Foundation, Charles Mansueto, PhD, and Ruth Golomb, LCPC, describe choosing strategies around the individual’s pattern and adjusting them with feedback.^[9]

That gives you something specific to discuss when a suggestion does not help. Is the urge still strong? Does the strategy meet the sensory need? Can you use it while working? Tell the therapist which part is difficult so you can refine the plan together.^[9]

Other approaches can complement habit reversal training. Acceptance and commitment therapy helps people experience urges without acting on them. Cognitive therapy examines beliefs about pulling. Treatment may also address accompanying anxiety, depression or substance use concerns.^[2]

Medication and Supplement Questions

A clinician may consider medication alongside therapy. The Merck Manual’s January 2026 review describes adult evidence for N-acetylcysteine, or NAC, and memantine. It also notes that a small study in children found NAC no better than an inactive treatment (a placebo). Adult findings should not be treated as a reason to give a child the same treatment.^[1]

Ask what symptoms the proposed treatment targets, how benefits and side effects will be monitored, and when you will review the decision. Bring a list of medicines and supplements you already take. A product being sold without a prescription does not answer whether it belongs in your care plan.^[2]

Recognizing Progress and Setbacks

ComB includes maintaining gains and planning for pulling to return. Review which situations remain difficult and whether the strategies still fit your life. The need to adjust a plan does not mean there is nothing else to try.^[9]

Consider a goal that matters beyond hair appearance, such as spending time with friends or concentrating on an activity without repeatedly checking your hair. Ask how treatment will help you track that goal alongside changes in pulling.

Supporting a Child or Teenager Who Pulls Hair

Arrange a medical appointment if you notice your child pulling out hair. Mention any hair eating as well. An examination can check for other explanations, such as a skin infection, and help identify the next step.^[5]

Ask prospective therapists about experience with your child’s age group and how caregivers participate. A younger child may need a different explanation or practice routine from a teenager. Ask what your role should be instead of assuming you should monitor every movement.

A conversation could begin: “I noticed your scalp looks sore. How does it feel? We can ask someone for help.” Keep the focus on comfort and support. Avoid public comments about hair loss, threats or turning the behavior into a test of obedience.

For a teenager, discuss privacy and what information they want shared with school staff. For an adult, ask permission before taking on an active role. Our mental health family-support guide offers ways to prepare for conversations and appointments.

Prepare for Care and Find a Therapist Near You or Online

Keuthen recommends noting when pulling happens, what you are thinking and how you feel, then sharing that information with a doctor. Her advice in Harvard Health Publishing centers on seeking evaluation when repeated pulling feels uncontrollable or is affecting life physically or emotionally.^[6]

The International OCD Foundation’s provider directory offers in-person and teletherapy searches. Provider information is self-reported, so confirm experience and availability directly. A listing is a starting point, not a guarantee that a clinician is the right match.^[10]

When contacting a local practice or an online therapist, ask:

• Experience. “Do you treat hair-pulling disorder in people my age?”
• Practical treatment. “Do you use habit reversal training or ComB? What would we practice between visits?”
• Physical care. “How would you coordinate with the clinician assessing my hair or skin?”
• Online eligibility. “Are you licensed to provide care where I will be located during sessions?”
• Access. “What are your fees, insurance arrangements and waiting times?”
• Progress. “When will we review whether this is helping, and what happens if it is not?”

If a practice does not treat hair pulling, ask whether it can suggest one that does. You can also tell the medical clinician what has made finding care difficult, such as cost, travel or appointment times.

In the U.S., call or text 988 for suicidal thoughts or emotional distress, including concerns about someone else. Call 911 for an immediate medical emergency or danger.^[11]