Trichotillomania: Why People Can't Stop Pulling Their Hair, and What Treatment Can — and Can't — Do
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 17, 2026
TL;DR: Trichotillomania (hair-pulling disorder) is a mental health condition marked by frequent, irresistible urges to pull out hair from the scalp, eyebrows, or other body areas [1]. It usually begins between ages 10 and 13 and often lasts a lifetime without treatment [1]. It is not a bad habit — it is part of a group of conditions called body-focused repetitive behaviors [1]. The main treatment is habit reversal training, a form of behavior therapy that teaches you to spot pulling situations and substitute other behaviors. Some medicines may help with related symptoms, though none are approved specifically for this condition.
Quick Answer
Trichotillomania is a mental health condition that causes repeated, hard-to-resist urges to pull out your hair, usually from the scalp, eyebrows, or eyelashes [1]. It most often starts between ages 10 and 13, is not likely to improve without treatment [1], and is best treated with habit reversal training — a behavior therapy. Some antidepressants and other medicines may also help.
What the research says
Behavior therapy has the strongest evidence. A 2020 meta-analysis of 24 randomized trials (857 participants) found that behavior therapy with habit-reversal components had a large benefit versus control conditions (SMD −1.22, 95% CI −1.71 to −0.73) (Farhat et al., Depress Anxiety, 2020) [3].
An earlier analysis agrees. A meta-analysis of 11 randomized trials reported a large pooled effect for behavior therapy (ES = 1.41) and a moderate pooled effect for serotonin reuptake inhibitors (ES = 0.41); trials with more therapist contact hours showed larger effects (McGuire et al., J Psychiatr Res, 2014) [4].
Some medicines beat placebo, but evidence is limited. Clomipramine (SMD −0.71), N-acetylcysteine (SMD −0.75) and olanzapine (SMD −0.94) each showed significant benefit versus placebo, but these results come from single trials that need replication, and no first-line medication is FDA-approved (Farhat et al., Depress Anxiety, 2020) [3].
What Is Trichotillomania?
Trichotillomania, also called hair-pulling disorder, is a mental health condition. It involves frequent, repeated, and irresistible urges to pull out hair from the scalp, eyebrows, or other areas of the body [1]. You may try to resist these urges, but you cannot stop [1].
The condition belongs to a group of disorders known as body-focused repetitive behaviors [1] [6]. Pulling hair from the scalp often leaves patchy bald spots [1]. This visible hair loss can cause significant distress and affect work, school, and social life, and people may go to great lengths to hide it [1].
For some people, trichotillomania is mild and can be managed. For others, the automatic or deliberate urge to pull hair feels too overwhelming to handle emotionally. The good news is that treatment options exist that may reduce hair pulling or stop it entirely.
Hair-pulling disorder is not a bad habit. It is a recognized mental health condition that is part of a group called body-focused repetitive behaviors — and it is not likely to improve without treatment [1].
What are the symptoms of trichotillomania (hair-pulling disorder)?
The symptoms of trichotillomania center on the pulling behavior itself, the feelings that surround it, and the visible hair loss it causes. Symptoms often include repeatedly pulling out hair — whether automatically or on purpose — usually from the scalp, eyebrows, or eyelashes, but sometimes from other body areas. The sites may shift over time [1].
There is typically an increasing sense of tension before pulling, or when resisting the urge, followed by a sense of pleasure or relief once the hair is out [1]. The hair loss is usually easy to see, such as shortened hair, thinned or bald areas, or thin or missing eyelashes and eyebrows [1].
Some people pull specific types of hair, follow the same steps each time, or pull in certain patterns [1]. Others bite, chew, or eat the pulled-out hair, or play with it by rubbing it across the lips or face [1]. Repeated attempts to stop — without success — and significant distress at work, school, or socially are also hallmarks [1].
Symptom Sign | What It Involves |
Repeated hair pulling | Automatic or deliberate; usually scalp, eyebrows, eyelashes, sometimes other areas; sites may change over time |
Rising tension | Builds before pulling or when trying to resist |
Relief or pleasure | Felt after the hair is pulled out |
Visible hair loss | Shortened, thinned, or bald areas; thin or missing eyebrows or eyelashes |
Rituals and patterns | Pulling specific hairs, same steps each time, certain patterns |
Biting, chewing, or eating hair | May involve pulled-out hair |
Playing with the hair | Rubbing pulled-out hair across lips or face |
Unsuccessful attempts to stop | Repeatedly trying to stop or pull less without success |
Distress and life impact | Problems at work, school, or in social situations |
Skin picking, nail biting, and lip chewing often occur alongside hair pulling [1]. In some cases, pulling hair from pets or dolls — or pulling fibers from clothes or blankets — may also be a sign [1]. Pulling is usually done in private, and an episode can last from a few seconds to hours [1].
Two Styles of Pulling
Hair pulling in trichotillomania can be automatic, focused, or a mix of both, depending on the situation and mood [1].
Pulling Style | How It Happens | Examples |
Automatic | Pulling without realizing it | While bored, reading, or watching TV [1] |
Focused | Pulling on purpose to relieve tension or distress | Searching for "just the right" hair; rituals; playing with, biting, or eating the hairs |
Certain positions or activities can trigger pulling — for example, resting your head on your hand or brushing your hair [1]. The behavior can also be tied to emotions in two directions: negative feelings such as stress, anxiety, tension, boredom, loneliness, extreme tiredness, or frustration can drive pulling, while the satisfying relief it provides can keep the cycle going [1].
The Long-Term Course
Trichotillomania is a long-term disorder. If left untreated, symptoms may come and go for weeks, months, or years at a time, and severity can vary over time [1]. For example, hormone changes during the menstrual period can worsen symptoms in some females [1]. Rarely, hair pulling ends within a few years of starting [1].
Causes: Why Does Hair Pulling Happen?
The exact cause of trichotillomania is not clear. Like many complex disorders, it likely results from a combination of genetic and learned factors [1]. What is known is that the condition is not a matter of willpower, and it does not simply disappear on its own.
What are the risk factors for trichotillomania?
Certain risk factors make trichotillomania more likely to develop, and the condition can affect children as well as adults.
Risk Factor | What It Means |
Family history | Genetics may play a role; a close relative with the condition raises the likelihood [1] |
Health conditions | Uncomfortable hair or skin conditions may focus attention on pulling or picking |
Age | Usually develops just before or during the early teens, most often between ages 10 and 13; often lifelong [1] |
Other mental health conditions | Depression, anxiety, or obsessive-compulsive disorder (OCD) may occur alongside it [1] |
Stress | Severely stressful situations or events may trigger the condition in some people [1] |
Environment | Boredom, isolation, and privacy increase the likelihood of pulling [1] |
It is worth noting that although far more women than men are treated for trichotillomania, this may simply reflect that women are more likely to seek medical advice [1]. In early childhood, the condition occurs just as often in boys and girls [1]. Baby hair pulling is usually mild and goes away on its own without treatment [1].
What complications can trichotillomania cause?
Although it may not seem serious from the outside, trichotillomania can have real harmful effects. Emotional distress is common — frustration, shame, embarrassment, and a feeling of losing control over the behavior — and it can bring low self-esteem, depression, anxiety, and problems with alcohol or drugs [1].
Hair loss may push people to avoid social activities, school, and job opportunities. Some wear wigs, style hair to disguise bald patches, wear false eyelashes, or avoid intimacy to hide the condition [1].
Constant pulling can also physically damage the skin and hair. Scarring, infections, and other damage to the scalp or pulling areas can permanently affect hair growth [1].
The most dangerous complication involves hair eating. Swallowed hair can form a large, matted hairball that stays in the digestive tract. Over years, the hairball can cause weight loss, vomiting, an intestinal block, and even death [1].
When should you see a doctor about trichotillomania?
If you cannot stop pulling out your hair, or if you feel embarrassed or ashamed about your appearance because of it, talk to your health care provider. Trichotillomania is a mental health condition, not a bad habit — and it is not likely to get better without treatment [1]. Seeking help is the first step.
How is trichotillomania diagnosed?
Diagnosing trichotillomania usually begins with a physical exam, followed by a possible referral to a mental health professional with experience treating the condition. The process typically includes examining the hair loss and checking for possible medical causes, which may involve lab tests.
The evaluation also involves talking with you about the hair loss — including the behaviors and emotions related to pulling — and identifying any physical or mental health conditions that may occur alongside it.
How is trichotillomania treated with therapy and medicine?
Some treatment options have helped many people reduce hair pulling or stop completely. These include therapy and sometimes medicine.
Treatment | How It Works | Key Points |
Habit reversal training | Main treatment; a behavior therapy teaching you to recognize pulling situations and substitute other behaviors, such as clenching your fists | One form, called decoupling, redirects your hand away from your hair the moment the urge arises |
Acceptance and commitment therapy | Teaches you to accept pulling urges without acting on them | Can be used alongside habit reversal training |
Cognitive therapy | Helps identify and examine unrealistic beliefs about hair pulling and build healthier ways of thinking about the condition | Addresses the thought patterns behind the behavior |
Therapy for related conditions | Treats co-occurring depression, anxiety, or alcohol and drug problems | An important part of overall treatment |
Medicines | May control symptoms such as anxiety and depression; no medicine is FDA-approved specifically for trichotillomania | An antidepressant such as clomipramine (Anafranil) may be recommended; research suggests N-acetylcysteine (an amino acid that affects mood) and olanzapine (Zyprexa) may also help |
The Main Treatment: Habit Reversal Training
Habit reversal training is the main treatment for trichotillomania [3]. It is a behavior therapy in which you learn to recognize the situations where you are likely to pull out your hair and how to substitute other behaviors instead — for example, clenching your fists to help stop the urge.
One specific form, called decoupling, involves quickly redirecting your hand from your hair to another location the moment the urge arises. Other therapies may be used together with habit reversal training.
Medicines: What Research Suggests
Although no medicines are approved by the U.S. Food and Drug Administration specifically for trichotillomania, some medicines may help control certain symptoms, such as anxiety and depression. A health care provider may recommend an antidepressant such as clomipramine (Anafranil). Research suggests that N-acetylcysteine, an amino acid that affects mood, may also help, and olanzapine (Zyprexa) — a drug used for certain serious mental health conditions — is another option research suggests may have benefit.
Always talk with your health care provider about any recommended medicine. The possible benefits should be balanced against possible side effects.
How can people cope with trichotillomania and find support?
Dealing with trichotillomania can be challenging, and you do not have to do it alone. Joining a support group for people with trichotillomania lets you meet others with similar experiences who can relate to your feelings and offer support. Having a family member or loved one join you — to learn how to respond to your hair pulling — can also help.
Your health care provider or mental health professional can suggest a support group. The TLC Foundation for Body-Focused Repetitive Behaviors is an excellent resource for education, support, and treatment options [5].
How should you prepare for a trichotillomania appointment?
Seeking help is the first step in treating trichotillomania. At first you may see your primary care provider or a dermatologist — a specialist in skin disorders. Your provider may then refer you to a mental health professional experienced in diagnosing and treating the condition.
Before your appointment, make a list of all your symptoms — even those that seem unrelated to hair pulling, since the condition can cause both physical and mental health symptoms. Note what triggers your urges, what you have tried, and what makes the urges better or worse. Include key personal information such as major stresses or recent life changes, and whether anyone in your family has the condition. Bring a list of all medicines, vitamins, herbs, and supplements with doses and duration, plus your questions.
Questions worth asking include what might have caused the condition, how it is diagnosed, whether it will go away on its own, and what treatments are recommended. If medicines are suggested, ask how long improvement takes and what the side effects are. You can also ask what you can do alongside treatment and how much improvement to expect.
Expect your doctor to ask questions such as when the pulling started, whether it is automatic or deliberate, what you feel before and after, and whether you bite, chew, or swallow the hair. Be ready to answer so you have time to discuss what matters most to you.
Conclusion: A Treatable Condition — You Do Not Have to Hide It
Trichotillomania is a real mental health condition, not a bad habit and not a character flaw. It causes repeated, hard-to-resist urges to pull out hair, usually begins between ages 10 and 13, and often persists without treatment. Left unchecked, it can damage hair, skin, and self-esteem — and in rare cases of hair eating, create serious digestive complications.
The encouraging reality is that treatment works for many people. Habit reversal training, the main therapy, teaches you to recognize pulling situations and substitute other behaviors, and some medicines can help control related symptoms such as anxiety and depression.
If you or someone you love cannot stop pulling hair, schedule an evaluation with your health care team rather than hoping it passes.
Frequently Asked Questions
What is trichotillomania?
Trichotillomania, also called hair-pulling disorder, is a mental health condition that causes frequent, repeated, irresistible urges to pull out hair — usually from the scalp, eyebrows, or eyelashes. It is part of a group of conditions known as body-focused repetitive behaviors. Pulling often leaves visible patchy bald spots and can affect work, school, and social life.
What causes hair pulling?
The exact cause is not clear. Like many complex disorders, trichotillomania likely results from a combination of genetic and learned factors. Pulling is often tied to emotions — it can relieve stress, anxiety, boredom, or tension, and the relief afterward keeps the cycle going. Certain positions or activities, like resting your head on your hand, can trigger it.
Is trichotillomania a bad habit?
No. Trichotillomania is a recognized mental health condition, not a bad habit or a matter of willpower. Because it is not likely to get better without treatment, people who cannot stop pulling should talk to a health care provider rather than trying to simply stop.
Who is most likely to develop trichotillomania?
Trichotillomania most often develops just before or during the early teens — usually between ages 10 and 13 — and is often lifelong. Risk factors include family history, uncomfortable hair or skin conditions, stress, boredom, isolation, privacy, and co-occurring conditions such as depression, anxiety, or OCD.
Can trichotillomania go away on its own?
Rarely, pulling ends within a few years of starting, but the condition is a long-term disorder and usually does not resolve without treatment. If left untreated, symptoms typically come and go for weeks, months, or years at a time, with severity that can vary.
How is trichotillomania treated?
The main treatment is habit reversal training, a behavior therapy that teaches you to recognize pulling situations and substitute other behaviors, such as clenching your fists. Acceptance and commitment therapy and cognitive therapy can also help. No medicines are FDA-approved specifically for the condition, but antidepressants and other drugs may help control related symptoms.
What is habit reversal training?
Habit reversal training is the primary behavior therapy for trichotillomania. You learn to identify situations where pulling is likely and replace pulling with another behavior — for example, clenching your fists when the urge strikes. A form called decoupling redirects your hand away from your hair the moment the urge arises.
Can medicines help with hair pulling?
No medicines are approved by the FDA specifically for trichotillomania, but some may help control symptoms such as anxiety and depression. Providers may recommend an antidepressant such as clomipramine (Anafranil). Research suggests N-acetylcysteine, an amino acid that affects mood, and olanzapine (Zyprexa) may also help. Benefits should be weighed against side effects with your provider.
Why do some people pull hair without realizing it?
Pulling can be automatic — happening without awareness during boredom, reading, or watching TV — or focused, meaning deliberate pulling to relieve tension or distress. Many people experience both styles depending on the situation and mood. Episodes, usually done in private, can last from seconds to hours.
Is hair pulling dangerous?
The behavior itself can cause scarring, infections, and permanent damage to hair growth. The most serious risk comes from swallowing hair: a large matted hairball can build up in the digestive tract over years, causing weight loss, vomiting, intestinal blockage, and even death. This makes early treatment important.
Related Reading
Habit Reversal Training: Steps, Uses and How It Works explains habit reversal training.
References
Mayo Clinic Staff. Trichotillomania (hair-pulling disorder): Symptoms and causes. Mayo Clinic. Nov. 22, 2023. https://www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188
Mayo Clinic Staff. Trichotillomania (hair-pulling disorder): Diagnosis and treatment. Mayo Clinic. Nov. 22, 2023. https://www.mayoclinic.org/diseases-conditions/trichotillomania/diagnosis-treatment/drc-20355193
Farhat LC, Olfson E, Nasir M, Levine JLS, Li F, Miguel EC, Bloch MH. Pharmacological and behavioral treatment for trichotillomania: an updated systematic review with meta-analysis. Depress Anxiety. 2020;37(8):715-727. PMID 32390221. https://doi.org/10.1002/da.23028
McGuire JF, Ung D, Selles RR, Rahman O, Lewin AB, Murphy TK, Storch EA. Treating trichotillomania: a meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors. J Psychiatr Res. 2014;58:76-83. PMID 25108618. https://doi.org/10.1016/j.jpsychires.2014.07.015
The TLC Foundation for BFRBs. The TLC Foundation for BFRBs. The TLC Foundation for Body-Focused Repetitive Behaviors. Accessed October 30, 2026. https://www.bfrb.org
American Psychiatric Association. Obsessive-Compulsive and Related Disorders. Psychiatry.org. Accessed October 30, 2026. https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder
National Institute of Mental Health. Obsessive-Compulsive Disorder (OCD). NIMH. Last reviewed December 2024. https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
Medical disclaimer
This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition.
Comments