How to Recognize and Manage Hair Pulling Disorder Effectively

Do you or someone you know struggle with a seemingly uncontrollable urge to pull hair? Do you think it’s just a weird habit, or could there be more to it? Maybe it’s something they do without even realizing, or perhaps it has a deeper meaning. What do you think?

Hair Pulling Disorder, or Trichotillomania, affects 2–4% of the population and is often misunderstood.  And no, It’s not just a “bad habit”. It’s a mental health condition that impacts lives in profound ways.

Catching trichotillomania early and addressing it head-on can make a huge difference.

This blog will help you understand what hair pulling disorder is and how to recognize the symptoms. We’ll also covers steps you can take to manage the condition effectively.

Whether you’re personally affected, studying psychology, or supporting someone with trichotillomania, this guide aims to provide clarity and comfort.

What Is Hair Pulling Disorder?

Trichotillomania, commonly known as Hair Pulling Disorder, is classified as a body-focused repetitive behavior (BFRB). It leads individuals to compulsively pull out their hair from the scalp, eyebrows, eyelashes, or other body areas. This behavior can result in noticeable hair loss, emotional distress, and disruptions to daily life.

Dr. Stephanie, a clinical psychologist, explains, “Recognizing trichotillomania as a valid mental health concern is crucial for early intervention and improved outcomes.”

For those with trichotillomania, the act of pulling hair offers temporary relief or pleasure, reinforcing the habit.

Here’s what some of our trichotillomania patients shared during interviews: 

• “Pulling out hair feels incredibly satisfying—it’s hard to resist.” 
• “There’s a specific urge to find strands with thick, white bulbs or ‘follicles,’ which makes the act even more gratifying.” 
• “If you don’t pull the hair, that persistent itchy sensation in the area just won’t go away.”

However, this relief is often accompanied by feelings of shame or guilt, creating a challenging emotional cycle.

What Are Body-Focused Repetitive Behaviors (BFRBs)? 

Gaining a deeper understanding of “Trich” requires exploring its place within a category known as body-focused repetitive behaviors (BFRBs). These are habits like hair pulling, skin picking, or nail biting—things people do over and over, often without even realizing it. 

While they might seem harmless at first, they can cause physical harm or emotional stress. BFRBs are often tied to feelings and emotions, which means managing them takes patience, understanding, and the right support.

Are BFRBs a Mental Health Condition?

Apparently, yes, Body-Focused Repetitive Behaviors (BFRBs) are considered mental health conditions. They fall under the category of obsessive-compulsive and related disorders in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

These behaviors often occur as a way to manage stress, anxiety, or other emotional states.

BFRB Triggers: What You Need to Know 

So you see, body-focused repetitive behaviors (BFRBs) don’t come out of nowhere. They’re triggered by valid emotions and feelings like

• Stress
• anxiety,
• boredom, or
• even sensory overload can set them off. 

But that’s not all. Surroundings can play a big role too. Certain places, situations, or routines might trigger these habits without you even realizing it. 

The key? Understand what’s behind your BFRBs. Once you do, you can build a strategy to manage and reduce them for good.

What Causes Hair Pulling Disorder?

The exact cause of trichotillomania, or hair-pulling disorder, remains unlear, but researchers believe it’s linked to a combination of biological, psychological, and environmental factors.

Understanding these factors can help make sense of why some people struggle with the urge to pull their hair.

Biological Factors:

• Genetics: If someone in your family has a history of obsessive-compulsive disorder (OCD) or body-focused repetitive behaviors (BFRBs), you might have a higher risk of developing trichotillomania. It’s not uncommon for these tendencies to run in families, though the connection isn’t fully understood.
• Brain Chemistry: Imbalances in brain chemicals like serotonin and dopamine, which help regulate mood and impulses, might play a role. When these chemicals are out of sync, it can make controlling urges much harder.

Psychological Factors:

• Stress and Anxiety: Many people with trichotillomania say they pull their hair during stressful periods. It might feel like a way to cope with overwhelming emotions, even if it creates more stress later. Recommended Read: Using Art for Anxiety Therapy
• Trauma or Emotional Pain: For some, past experiences or trauma could contribute to the behavior. Pulling can feel like a way to self-soothe or regain a sense of control when emotions are too intense to handle.
• A Coping Mechanism: Hair pulling often becomes a way to deal with feelings like frustration, sadness, or even boredom. It provides a temporary sense of relief or comfort, making it hard to stop.

Environmental Triggers:

• Boredom or Routine: Sometimes, pulling happens during moments of idleness, like watching TV, reading, or lying in bed. Without even realizing it, your hands might wander to your scalp or another area.
• Sensory Triggers: The texture of hair, the sensation of pulling, or even seeing a strand out of place can spark the urge. It’s not just about the action; for some, it’s the satisfaction of feeling the hair or seeing it come loose.
• Specific Locations or Situations: Certain environments, like sitting at a desk, being alone, or looking in a mirror, can unintentionally encourage pulling.

During one of our CBT sessions, a patient asked, “Why does pulling hair feel good?”

You might find that question weird since for others, hair pulling is often painful.

The answer lies in a complex mix of psychological and physiological factors. For some, hair-pulling offers temporary relief from built-up tension or anxiety. This happens because the act triggers the brain’s reward system, reinforcing the behavior over time.

If you’re struggling with trichotillomania, remember—you’re not alone. There are resources and support available to help.

Common Signs and Symptoms of Trichotillomania

Trichotillomania is a complex and often underrecognized condition with potentially serious consequences if left untreated. It can lead to significant emotional distress, skin infections from repeated hair pulling, and in severe cases, trichobezoars—hairballs in the digestive system that can cause dangerous blockages.

Early recognition of the symptoms is key to accessing effective treatment and support.

Physical Symptoms:

The physical signs of trichotillomania are often visible and can vary depending on the severity of the hair-pulling behavior.

These symptoms may include:

• Bald patches or thinning hair: Repeated hair pulling can cause noticeable bald spots on the scalp, eyebrows, eyelashes, or other targeted areas. In more severe cases, this behavior may lead to permanent hair loss or scarring from constant pulling.
• Skin irritation or infections: Repeated pulling can lead to red, irritated skin or even infections in the affected areas.
• Presence of broken hair: Hair that has been pulled and has started to regrow may appear uneven or stubbly in certain areas.

These physical signs can lead to self-consciousness and a desire to hide areas of hair loss, adding to the emotional toll of the condition.

Emotional and Behavioral Symptoms:

Trichotillomania is not just a physical condition; it also comes with a range of emotional and behavioral challenges. These symptoms often provide insight into the internal struggles individuals may face:

• Feeling tension or anxiety before pulling hair: Many individuals report a buildup of tension or stress that is temporarily relieved by pulling their hair.
• A sense of relief or gratification after pulling: Hair-pulling often provides a momentary sense of comfort, satisfaction, or relief, even though it can lead to guilt or frustration later on.
• Secretive behaviors or denial: People with trichotillomania may go to great lengths to hide their behavior, such as avoiding certain social situations, wearing hats or wigs, or denying that they pull their hair.

These emotional and behavioral patterns can create a cycle of shame and isolation, often making it harder for individuals to seek support.

How to Differentiate:

It’s important to understand the difference between occasional hair-pulling and trichotillomania. Many people pull their hair occasionally, especially during stressful moments or while fidgeting.

However, trichotillomania goes beyond occasional behavior. It is characterized by:

• Chronic hair-pulling: The behavior occurs frequently and is difficult to control.
• Significant distress: The individual feels emotional pain, shame, or frustration about their behavior.
• Interference with daily life: The condition affects work, school, relationships, or overall quality of life.

If hair-pulling is persistent, causes emotional distress, or interferes with your ability to live a normal life, it may be time to seek professional help. 

Trichotillomania is a real and treatable condition, and understanding these signs can be the first step in finding the right support and treatment.

Trichotillomania: Who Is at Risk?

Hair pulling disorder can affect people of all ages, but certain groups are more likely to experience it.

Here’s a closer look at the demographics and related mental health conditions commonly associated with trichotillomania:

Demographics:

• Trichotillomania often begins in childhood or adolescence, around ages 10–13.
• Approximately 80–90% of individuals diagnosed as teenagers and adults are female.

Co-Occurring Conditions:

Many individuals with trichotillomania also experience other mental health challenges:

• OCD (Obsessive-Compulsive Disorder)
• Anxiety disorders
• Depression

How to Recognize If You Have Hair Pulling Disorder

Self-Assessment: 

Just like taking an anxiety assessment, you can reflect on these questions to better understand your experience: 

• Do you find yourself pulling your hair often, sometimes without even noticing? 
• Does the act of pulling your hair bring a sense of relief or satisfaction? 
• Have you noticed physical signs, such as bald spots or thinning patches? 
• Has this habit impacted your daily life, relationships, or self-confidence? 
• Do you experience feelings of shame, guilt, or frustration about pulling your hair?

If your answers to these questions raise concerns, seeking professional help can provide clarity and support.

Professional Diagnosis:

A therapist or psychiatrist can evaluate your symptoms, ruling out underlying medical causes and offering a formal diagnosis. “Early diagnosis can lead to more effective treatment and better outcomes,” explains Dr. Stephanie.

Treatment Options for Hair Pulling Disorder

Treatment for trichotillomania often requires a combination of approaches tailored to the individual. 

Here are the most common options:

1. Cognitive Behavioral Therapy (CBT)

CBT, specifically Habit Reversal Training (HRT), is one of the most effective treatments. HRT teaches individuals to recognize pulling urges and replace them with healthier habits.

2. OCD Therapy

OCD Therapy for trichotillomania often involves Exposure and Response Prevention (ERP), helping individuals confront and manage the urge to pull hair. It can be customized to address specific triggers and habits, improving self-control and overall well-being.

3. Medications

Selective serotonin reuptake inhibitors (SSRIs) and other medications may help regulate impulses and manage co-occurring conditions like anxiety or depression.

4. Support Groups

Sarah, a support group coordinator, shares, “Sharing experiences and learning from others in a supportive environment can be empowering in the recovery from Hair Pulling Disorder.” Look for local or online groups to connect with others who understand your struggles.