Trichotillomania: Understanding the Hairpulling Disorder

Medically Reviewed by Zilpah Sheikh, MD on December 07, 2023
15 min read

Trichotillomania is a type of impulse control disorder where people have an irresistible urge to pull out their hair, usually from their scalp, eyelashes, and eyebrows. It's also called hairpulling, hairpulling disorder, TTM, and trich. Mental health professionals think of trichotillomania as a “body-focused repetitive behavior.” Body-focused repetitive behaviors are habits like pulling your hair, biting your nails, or chewing on your lips that become extreme or get in the way of enjoying life.

Most commonly, people with trichotillomania pull out hair from their scalp. They may also pull out their eyelashes, eyebrows, facial hair (like beards or mustaches), or armpit, leg, or pubic hair. Often, they pull when they're stressed or bored as a way to soothe themselves.

Trichotillomania is a type of impulse control disorder. People with these disorders know that it might be harmful if they act on an impulse like hairpulling, but they cannot stop themselves. Trichotillomania can cause hair loss, including uneven bald patches, that can make people feel self-conscious or embarrassed. This can lead to emotional distress or avoiding social situations. Even though having trichotillomania or pulling your hair is not your fault, there can be social stigma around talking about it.

How common is trichotillomania?

Doctors aren't sure exactly how common trichotillomania is because many people who have it don't tell their doctors. Stigma can make it hard to ask for help. Scientists think 3.5% of all people experience hairpulling at some point in their life, and it might be higher.

Why does pulling hair feel good?

For many people with trichotillomania, hairpulling is a response to stress, frustration, or boredom. It can feel comforting and give you a place to direct your energy or something to do. Even if you know you might feel upset about it later, pulling can feel pleasant and satisfying in the moment. It might also help you feel in control during stressful situations.

Hairpulling can become a habit. This creates a cycle in your brain where you think about the habit and feel the urge to do it. When you do, your brain releases “reward” chemicals like dopamine, which makes you feel happy and calm. Your body then connects doing the habit with feeling good, which in turn strengthens the habit and makes the urge to do it more intense. For people who feel a strong urge to pull, actually pulling can bring a sense of relief because they are no longer focused on the urge.

Some people with trichotillomania have rituals or routines related to hairpulling, like choosing which hair to pull or smelling, looking at, playing with, or eating hair you pull out. Rituals of all kinds can be soothing or pleasing to people. Many people also enjoy the sensory experience of the rituals they develop around hairpulling. This can involve any of the senses, such as the sound of pulling out a hair or rubbing it against your hand, the feeling or taste of hair in your mouth, or other sensations.

Hairpulling sometimes helps people feel in control of unpleasant physical sensations. For example, some people with trichotillomania who pull on their eyelashes say that they feel an eyelash getting in the way when they blink, so they try to remove the one that's bothering them. In the process, they end up pulling out more eyelashes or get in the habit of pulling. Other people say they feel itchiness or tingling in the area they pull on, and pulling helps get at the itch.

The main symptom of trichotillomania is pulling out your hair, often to the point that you have hair loss or bald patches. People with trichotillomania often try to stop pulling but can't. They also say that pulling has negative effects on their lives, self-esteem, or well-being.

Pulling can be focused or automatic. With automatic pulling, you aren't aware that you're doing it. Automatic pulling might happen when you're studying, reading, or watching TV and not paying attention. Automatic pulling can be a response to feeling bored.

With focused pulling, people know that they are doing it but can't stop themselves. Focused pulling can be a way to ease stress or soothe yourself. People sometimes have rituals or routines for focused pulling, like playing with the hair you pull, tasting it, or smelling it. You might feel relieved or calmer after focused pulling.

Most of the time, people with trichotillomania pull out their hair with their fingers, but you might also use tweezers or other tools.

Other signs of trichotillomania

Besides repeated hairpulling, other signs of trichotillomania may include:

  • Feeling tense before pulling out your hair or if you try to resist the urge to pull
  • Feeling relieved, satisfied, or pleased after acting on the impulse to pull hair
  • Distress or problems at work, at school, or in your social life due to hairpulling
  • Avoiding situations where people might find out that you pull hair or have hair loss, like sleepovers, swimming, going outside in windy weather, hair salons or barber shops, changing rooms, or sexual intimacy with a partner
  • Conflicts or tension with your friends or family related to pulling
  • Irritated or sore skin from pulling or a tingling feeling or itch that makes you want to pull
  • Scars or damage to your skin, scalp, or hair follicles
  • Rituals like chewing on the hair you pull out, inspecting the hair root, twirling the hair, putting the hair between your teeth, or eating hair
  • A preference for certain types or textures of hair
  • Changes to how you look because of hair loss
  • Bare patches where your hair has been pulled out
  • Pulling fibers from blankets and clothing or hair from pets or dolls

If you have trichotillomania, you could also have other body-focused repetitive behaviors, like nail biting, skin picking, or chewing on your lips or cheeks. About 1 in 5 people with trichotillomania also have trichophagia, a related condition that causes you to eat the hair you pull out. If you eat hair, it can lead to problems with digestion like throwing up, nausea, and stomachaches. Over time, you might get blockages or holes in your digestive tract as hair builds up.

Many people who have trichotillomania feel embarrassed or ashamed to let other people know they pull. They may try to hide their bald patches or hair loss with hats, scarves, or wigs. They might also wear false eyelashes or use makeup to try to cover up the physical effects of trichotillomania. This can be expensive or take a lot of time to do. Some people will stay at home or avoid social situations if they are self-conscious about their hair loss or pulling.

The exact cause of trichotillomania isn't known. Scientists are still learning about it, but they think it might be linked to differences in the parts of your brain related to impulse control, learning, emotion, and movement. It might also be connected to brain chemicals, psychology, your environment, and stress.

Some things may boost your risk of trichotillomania, including:

  • Age.Young children sometimes pull out their hair as a way of soothing themselves, and they often outgrow it. More serious forms of trichotillomania often start in the early teens, between ages 10 and 13. Some doctors think it might be linked to the changes in your hormones that happen during puberty. Trichotillomania can last your whole life, though symptoms may come and go.
  • Genes. In some families, the tendency to trichotillomania may be passed on. You're more likely to get it if other people in your family have it.
  • Gender. People of all genders can have trichotillomania. In children and teenagers, the rate of trichotillomania is the same across genders. But adult women are up to nine times more likely than adults of other genders to get diagnosed with it. Some scientists think that this is because people who identify as women might be more likely to tell their doctors about hairpulling or that doctors might pay more attention when women talk about it. Some doctors think hormone changes might affect trichotillomania in people who get periods (menstruate).
  • Other mental health disorders. If you live with trichotillomania, you may have other mental health conditions, such as anxiety, depression, or obsessive-compulsive disorder (OCD).
  • Stress. Extreme stress may trigger trichotillomania in some people. Stress can be caused by situations including family conflict, abuse, or the death of a friend or family member.
  • Boredom. Some people start pulling their hair as a way to cope with being bored and then it becomes a habit.

Your doctor or mental health care professional can diagnose you with trichotillomania based on your symptoms. There are no specific tests for it, but your doctor will ask you questions about your habits, stress levels, and experiences pulling your hair. They'll check to make sure you don't have other conditions that could cause pulling or hair loss.

Sometimes, your doctor might take a very small piece of skin to look for certain kinds of damage that can happen from pulling. This is called a punch biopsy. They might also look at your hair under a microscope to see if it looks like it's been pulled out and grown back or look at how much hair you are missing. They may take pictures of your bald patches to help track if treatment works over time.

They might send you to a psychiatrist, psychologist, therapist, or other mental health care professional. Your mental health care provider will also ask questions about your hairpulling, your life, and your overall mental health to help figure out what's going on. They will help you learn ways to manage your trichotillomania.

Doctors use a guidebook called the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5), to diagnose mental health conditions, including trichotillomania. According to the DSM-5, people with trichotillomania have these five things in common:

  1. You pull your hair out.
  2. You have tried to stop yourself from pulling but couldn't resist the urge.
  3. You feel distressed or upset about pulling or it has negative effects on your life or self-esteem.
  4. Your pulling isn't caused by another medical issue.
  5. Your pulling isn't caused by another mental health issue.

Treatment options for trichotillomania include:


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

  • Acceptance and commitment therapy. You'll be able to practice accepting the hairpulling urges without actually hairpulling.
  • Habit reversal. This is often the main treatment of trichotillomania. It'll help you practice other, less harmful habits instead of hairpulling, 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 hairpulling.


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

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

People with trichotillomania have come up with different ways to help themselves resist the urge to pull. These include:

  • Distractions. Some people might play with a fidget toy or stress ball, knit or crochet, give themselves a manicure, doodle, do a craft project like wood carving or origami, or something else to keep their hands busy when they are bored or feel the urge to pull.
  • New routines or rituals. Many people with trichotillomania have specific routines around pulling that feel good to them. Some people try to create new routines to do instead of pulling. Some examples are repeating a saying you like, giving yourself a hand massage, doing physical exercise, or tightening and then releasing different muscles.
  • Stress management and mindfulness. Sometimes, people pull in response to stress. It might be helpful to use stress management techniques like deep breathing, meditation, or taking a hot bath until the urge goes away.
  • Different sensations. Many people with trichotillomania enjoy certain sensory aspects of pulling, chewing on or smelling their hair, or playing with it in their hands. They might feel itchiness or tingling in the area they pull. Using itch relief cream, putting a washcloth or cold water on the area, or doing something that has a sensation you enjoy might be useful.
  • Making it harder to get to your hair. People sometimes wear hats, scarves, or bandanas to stop themselves from pulling. They might tie their hair back in braids, ponytails, locs, or other styles that make it harder to reach or cut it short. If you use tools like tweezers to pull, you can try hiding them or putting them in a different place each time you use them.

Your doctor or mental health professional can help you figure out which ideas might work best for you. Together, you will come up with a personalized plan to treat your trichotillomania. They will work with you to learn and practice different strategies.

Like other body-focused repetitive behaviors, trichotillomania can cause great distress to people who have it. Without treatment, it can lead to different kinds of complications including:

  • Emotional issues and stigma. People say they feel ashamed or embarrassed about pulling or hair loss. This can affect self-esteem and self-confidence. People who are too embarrassed to talk about their pulling might feel like they are carrying a big secret or weight. Even though it's not the person's fault, there is still stigma around having trichotillomania. People might worry that no one will understand or that they are the only ones who pull. This can all lead to shame, guilt, or other difficult feelings. These feelings might affect their relationships with their loved ones.
  • Problems at work, at school, or in social settings. People with trichotillomania may avoid friendships, relationships, and intimacy. They might turn down school or job opportunities because they feel down about themselves or embarrassed about pulling. They also might avoid situations like changing rooms, swimming, sleepovers, and overnight trips, where other people might be more likely to notice their pulling or hair loss. This can lead to isolation, feeling left out, or feeling like you don't belong.
  • Damage to your scalp, skin, or hair. People with trichotillomania often have hair loss or bald or uneven patches on their scalp, body, or face. Repeated pulling can leave tiny scars on your scalp, skin, or hair follicles. Sometimes, this scarring makes it harder for the hair to grow back. People can also get infections or damage to the tissue.
  • Complications from eating hair (trichophagia). About half of all people with trichotillomania put the hair they pull in their mouth in some way, and 1 in 5 swallow or eat it. Hair is hard for your body to break down, so swallowing it can lead to digestive system problems like stomachaches, nausea, throwing up, or blockages. It's rare, but sometimes, undigested hair can clump together in your digestive tract and form a tight wad or ball, called a trichobezoar. Trichobezoars can cause blockages and holes in your intestines or other digestive organs, ulcers, weight loss, and other problems. It's important to see a doctor right away if you swallow the hair you pull and you start to have any digestive system issues. If you have a trichobezoar, your doctor will do surgery to take it out.

Trichotillomania and eyebrows

Some people with trichotillomania also pull out the hair from their eyebrows. This goes beyond usual grooming, and people have trouble resisting the urge to pull their eyebrows. You might use your fingers, tweezers, or other tools. If you only pull your eyebrows, and not any other hair, it's sometimes considered a minor form of trichotillomania.

Some people feel itchiness or tingling in their eyebrows and pull in response. Other people pull or over-pluck their eyebrows because they are worried about how they look or to help themselves deal with stress.

The skin near your eyebrows is sensitive and can easily get hurt from pulling. If you end up with damage to this area, it will be harder for them to grow back, and they might not be able to grow back all the way. In general, it takes about 3-4 months for eyebrow hair to grow, and it might take longer if your hair or skin has been affected by pulling. To help prevent damage, doctors say to pull your eyebrow hair in the same direction it grows and use angled metal tweezers with sharp, skinny points. Tweezers with rubber tips or wide, flat points are rougher on your hair and skin, which makes it harder for eyebrows to grow back.

A doctor or mental health professional can help you recover from trichotillomania and stop pulling. Some people also put cold water, a wet washcloth, coconut oil, or anti-itch cream on their eyebrows. They might also hide their mirrors or tweezers or wear clear glasses to stop themselves from plucking.

If you are trying to get your eyebrows to grow back, some doctors recommend taking vitamins like iron, omega-3 supplements, biotin, and a multivitamin. Always check with your doctor about any vitamins or supplements you want to take. Your doctor might give you certain medications or creams to help eyebrow hair grow back. In some severe cases where eyebrows don't grow back, they might suggest getting permanent eyebrow tattoos or hair transplants.

Trichotillomania and eyelashes

Pulling out your eyelashes can be an issue for you if you have trichotillomania. Eyelashes can be painful to pull, and scientists think that the pain might lead to relief or pleasure. People who pull their eyelashes sometimes say that they feel an eyelash getting caught when they blink, so they try to remove it.

People may pull their lower or upper eyelashes or both. Because eyelashes protect your eyes from dust and other irritating things, pulling them out can make you more likely to get eye infections and injuries. Pulling can also hurt the delicate skin on your eyelids, which makes it harder for eyelashes to grow back.

If you pull your eyelashes, your eye doctor might tell you to put eye ointment on your eyelids to moisten the area and help the hair grow back. In general, eyelashes replace themselves in 6-10 weeks, but it might take longer if your eyelids are damaged from pulling. Your eye doctor might recommend medications or special creams to help your eyelashes grow back. These treatments can have risks, so make sure to let them know if you pull to help them find the right treatment for you.

Eating plenty of fruits, vegetables, protein, and foods with iron in them (red meat, beans, etc.) may help your eyelashes grow faster.

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 because stress often triggers hairpulling behavior.

Trichotillomania is an uncontrollable urge to pull out your hair that can lead to hair loss, bald patches, and feelings of shame, embarrassment, or isolation. Many people with trichotillomania try to hide their pulling, but help is available. If you struggle with hairpulling, talk to your doctor or a mental health professional.

  • Is trichotillomania an OCD or anxiety?

According to some experts, trichotillomania is a type of OCD. OCD is a mental health condition that causes overwhelming thoughts that are hard to move on from, called obsessions. These obsessions lead to compulsions, which are actions that you can't stop yourself from doing over and over. People with OCD often feel anxiety or fear about their obsessions. For example, someone might worry obsessively about things being out of order and feel a compulsion to arrange their things in a certain order.

While everyone has some obsessive thoughts or compulsions once in a while, if you have OCD, these thoughts and actions have strong, negative effects on your life and make it hard to do daily tasks. Like the urge to pull for people with trichotillomania, they can be very hard or impossible to ignore.

Other experts think that trichotillomania is different from OCD, for a few reasons: First of all, many people with trichotillomania feel satisfied, relieved, or happier after they pull. People with OCD usually don't feel better after they do one of their compulsions. Also, people with trichotillomania often pull without thinking about it and don't have obsessive thoughts like with OCD. Treatment of trichotillomania and OCD is often different. Because of this, trichotillomania and OCD can be thought of as “cousins.”

Trichotillomania is also linked to anxiety, but scientists don't fully understand the relationship. For example, some people with trichotillomania might feel anxious or depressed because they are embarrassed about pulling. Other people might start pulling as a way to deal with stress or anxiety. We do know that about 3 out of 5 people with trichotillomania also have anxiety.

Make sure to tell your care team if you experience obsessive thoughts, compulsions, anxiety, or fear. Your mental health professional can help you figure out if you have OCD or an anxiety disorder and include helping you feel better in your treatment plan.

  • Is trichotillomania related to attention deficit hyperactivity disorder (ADHD)?

ADHD is a mental health condition that affects focus, attention, activity, and concentration. While ADHD is not an impulse control disorder like trichotillomania, it can cause problems with impulse control. For this reason, scientists think ADHD and trichotillomania might have some connection with each other, but scientists are still learning about these links.

So far, studies have shown that people with trichotillomania are more likely to also have ADHD. In one study that looked at people with trichotillomania, almost 1 in 6 also had ADHD. In general, only about 2 or 3 out of 100 people have ADHD. People who have ADHD and trichotillomania might have more issues with controlling their impulses than people who only have one condition. Scientists think some people with ADHD might pull to help themselves focus. People who have trouble paying attention also might not notice if they are pulling out their hair.