Medically Reviewed by Stephanie S. Gardner, MD on April 26, 2022
3 min read

Trichotillomania, also known as “hair-pulling disorder,” is a type of impulse control disorder. People who have trichotillomania have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows. They know they can do damage but often can’t control the impulse. They may pull out their hair when they're stressed as a way to try to soothe themselves.

Trichotillomania is a type of impulse control disorder. People with these disorders know that they can do damage by acting on the impulses, but they cannot stop themselves. They may pull out their hair when they're stressed as a way to try to soothe themselves.

Besides repeated hair pulling, other symptoms may include:

  • Feeling tense before pulling hair or when trying to resist the urge to pull hair
  • Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
  • Distress or problems in their work or social life due to hair pulling
  • Bare patches where the hair has been pulled out
  • Behaviors such as inspecting the hair root, twirling the hair, pulling the hair between the teeth, chewing on hair, or eating hair
  • A preference for certain types or textures of hair

If you have trichotillomania, you could also have other disorders that often come with it, like onychophagia (nail biting) or skin picking disorder. Pulling fibers from blankets or hair from dolls are other signs you could have trichotillomania.

Many people who have trichotillomania try to deny they have a problem and may attempt to hide their hair loss by wearing hats, scarves, and false eyelashes and eyebrows.

The exact cause of trichotillomania isn't known. It may be related to changes in brain pathways that link areas involved in how you manage your emotions, movement, make habits, and control your impulses.  

Some things may boost your risk of trichotillomania, including:

  • Age. Trichotillomania usually starts in the early teens, between ages 10-13. It can last throughout life, though symptoms may come and go.
  • Genes. In some families, the tendency to trichotillomania may be passed on. It’s more likely if another family member has it.
  • Other mental health disorders. If you live with trichotillomania, you may have other mental health problems, such as anxiety, depression, or obsessive-compulsive disorder (OCD).
  • Stress. Extreme stress may trigger trichotillomania in some people. Stress can be triggered by situations including family conflict, abuse, or the death of a friend or family member.

Trichotillomania is diagnosed based on its symptoms. There’s no specific test for it.

A doctor might refer someone who has symptoms of trichotillomania to a psychiatrist or psychologist, who can interview the person and see if they might have an impulse control disorder.


Many types of therapy can support people with trichotillomania and even help them stop hair pulling completely.  

  • Acceptance and commitment therapy. You’ll be able to practice accepting the hair-pulling urges without actually hair pulling.
  • Habit reversal. This is often the main treatment for trichotillomania. It’ll help you  practice other, less harmful habits instead of hair pulling, like clenching your fists when you have the urge to pull your hair.
  • Cognitive therapy. This helps people explore and change the beliefs that lead to hair pulling.


There are no FDA-approved medicines for trichotillomania, but these drugs may control symptoms in some people:

  • Antidepressants
  • Atypical antipsychotics
  • N-acetyl-cysteine, an amino acid supplement

Trichotillomania can cause great distress to people who have it. Many say they feel shame and  embarrassment, and they often have low self-esteem. Other complications can include:

  • Problems at work and in social settings. People with trichotillomania may shy away from social situations and friendships and even turn down job offers because they’re embarrassed about pulling.
  •  Skin and hair damage. Constant tugging can leave scars on the scalp and affect hair growth long-term.
  • Hairballs. These are large, matted wads of hair called trichobezoars that form in the GI tract. Over time, they can cause weight loss and blockages.

There is no proven way to prevent trichotillomania, but getting treatment as soon as symptoms start can be a big help. Learning stress management is also a good idea, since stress often triggers hair-pulling behavior.

Show Sources

Photo Credit (inset): Richard Usatine, MD


Trichotillomania Learning Center.

Mayo Clinic: "Trichotillomania (hair-pulling disorder)."

PubMed Health: "Trichotillomania." “What is Trichotillomania? A Closer Look at Hair-Pulling Disorder.”

Mental Health America: “Trichotillomania (Hair Pulling).”

The TLC Foundation for Body-Focused Repetitive Behaviors: “Nail Biting (Onychophagia).”

Mental Health America – Photo Caption

Cleveland Clinic – Photo Caption

Nemours KidsHealth – Photo Caption

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