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Understanding Trichotillomania


Trichotillomania or hair pulling is a disorder where a person constantly has the urge to pull their hair from the scalp, eyebrows, beard, legs, arms or other parts of the body. For some, hair pulling can be managed but for others the urge to pull hair is overwhelming. Individuals with this disorder may pull their hair because they are stressed and need to find a way to soothe themselves. It is classified as an impulse control disorder. It can start around the ages of 12 or 13 but it is not uncommon for it to start at a younger or older age. This post will describe the symptoms, causes and treatment options for trichotillomania?

Symptoms include:

  1.  Constantly pulling out one’s hair
  2. Pleasure or relief when pulling out the hair
  3. Noticeable hair loss due to pulling one’s hair
  4. Distress in social life due to pulling one’s hair
  5. bare patches due to pulling hair
  6. denial that they are pulling their hair

Individuals with this disorder may pull their hair at any time. They may pull hair in private to hide the disorder from other people.  The most common times a person may pull their hair tend to be when:

  1. watching television
  2. sitting at the computer
  3. reading a book
  4. laying in bed
  5. overwhelmed with stress (positive or negative stress)

Stress can cause this to get worse. Positive stress such as preparing for a vacation or getting married and negative stress such as studying for an exam, financial problems or problems at work can equally make a person stressed or anxious resulting for increased hair pulling.  Tension, anger, boredom and frustration also may trigger a person to pulling their hair. For some people pulling hair can be focused (to relieve tension) or automatic (some do not realize they are doing it). The same person can do both automatic and focused and certain rituals may trigger hair pulling such as brushing your hair.


The causes are unknown. It could be genetics or environmental or both.

Treatment includes:

Education, medication and therapy, specifically behavior therapy, tend to be the most effective. I had a client with trichotillomania where I used the Habit Reversal Training. It is a behavior therapy that is effective in reducing trichotilomania. It consists of four phases:

  • awareness where the person describes each time they do the behavior, learns to identify the early signs, urges or thoughts, and the person identifies the situations in which the behavior occurs. A person develops a good awareness of the early signs both internal and external that prompts them to hair pulling.
  • developing a competing response where the person develops a competing response that replaces the impulsive behavior. For example, if a warning sign was to put their hand on their chin and then pull their hair,  they would make their hand into a fist and then place that hand on their lap until the urge passes.
  • building motivation where the person makes a list of all the problems the impulsive behavior caused
  • practice new skills in different contexts

Joining a support group may help so the person can meet others with similar experiences. If you or someone you know is suffering from trichotillomania you can visit Trichotillomania Learning Center website to find a support group near you.



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Understanding Trichotillomania

Helen Nieves

Helen Nieves is a Licensed Mental Health Counselor and Certified Attention Deficit Consultant Specialist. She teaches ADHD on line and is on the Advisory Board at The American Institute of Health Care Professionals. She also received advanced training in Rational Emotive Behavior Therapy and in Grief Counseling.

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APA Reference
Nieves, H. (2015). Understanding Trichotillomania. Psych Central. Retrieved on July 14, 2020, from


Last updated: 16 Apr 2015
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