Trichotillomania (Hair-Pulling Disorder)

Understanding Trichotillomania, Urges, and the Cycle of Pulling and Relief

Trichotillomania is a Body-Focused Repetitive Behavior (BFRB) involving repetitive pulling of hair from the scalp, eyebrows, eyelashes, face, or body. Individuals often feel strong urges or sensations before pulling, followed by temporary relief or satisfaction, and then shame, frustration, or guilt.

This is not a habit, a lack of discipline, or something you can "just stop."
It is a neurobiological condition that requires skill-based, compassionate treatment.

Many people hide hair loss, avoid mirrors, or cancel social plans due to embarrassment. If this sounds familiar, you are not alone and effective help exists.

What Is Trichotillomania?

Trichotillomania (TTM) is characterized by:

  • Recurrent pulling of one’s hair

  • Repeated attempts to stop

  • Visible hair loss or damage

  • Emotional distress or impairment

Pulling can be:

  • Focused (intentional, done to relieve stress or tension)

  • Automatic (done without awareness for example while reading, watching TV, thinking)

Both forms are common and treatable.

Common Triggers for Hair Pulling

Triggers may include:

  • Stress or anxiety

  • Boredom or inactivity

  • Fatigue

  • Perfectionism

  • Sensory discomfort (itch, uneven hair, coarse texture)

  • Emotional overwhelm

  • Transitions or unstructured time

  • Being alone

Many clients report “urge waves” that come and go.

Common Experiences

People with Trichotillomania often describe:

  • Feeling a strong “need” or tension before pulling

  • Temporary relief during the behavior

  • Difficulty stopping mid-episode

  • Shame or panic afterward

  • Wearing makeup, hats, or hairstyles to hide hair loss

  • Avoiding photos or social events

These patterns are part of the disorder and are not a reflection of character or strength.

How We Treat Trichotillomania

The most effective treatment includes a combination of behavioral, cognitive, and sensory strategies.

1. Habit Reversal Training (HRT)

Clients learn to:

  • Identify triggers and early warning signs

  • Increase awareness during automatic pulling

  • Use competing responses to interrupt urges

  • Build coping strategies that replace pulling

2. Stimulus Control

We help modify environments to reduce automatic pulling:

  • Wearing finger barriers

  • Adjusting lighting

  • Setting up pull-free zones

  • Changing routines that increase urges

3. Comprehensive Behavioral Treatment (ComB)

Addresses the emotional, cognitive, sensory, and environmental factors behind pulling.

4. ERP-Informed Techniques

When pulling overlaps with OCD or anxiety, we use:

  • Exposure to urges

  • Reducing avoidance

  • Tolerating discomfort without engaging

5. Nervous System Regulation

Urges often decrease when we regulate underlying tension.

Common Questions About Trichotillomania

  • Because Trichotillomania is a brain-based condition, not a choice or habit.

  • It is a related disorder. Many people have both OCD and Trichotillomania.

  • No. Treatment is gradual, collaborative, and focused on building skills.

  • Hair can regrow in most cases, but chronic pulling may affect regrowth over time.

  • Medication may help underlying anxiety or urges but is not a primary treatment.

When to Reach Out for Help

If hair pulling feels out of control or emotionally overwhelming, specialized support can help you build confidence and reduce urges.

At The OCD Relief Clinic, we help individuals:

Understand their triggers

Build replacement skills

Reduce pulling episodes

Heal shame

Improve daily functioning


Learn more about Body-Focused Repetitive Behaviors and related conditions.


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