Find a Trichotillomania Therapist

Trichotillomania, also called Hair Pulling Disorder, involves repeated urges to pull out one’s hair. This can lead to noticeable hair loss, emotional distress, and interference with daily functioning. Many people feel a sense of tension before pulling and relief or satisfaction afterward.

Ask yourself:

• Do I feel unable to stop pulling my hair?
• Is it affecting my relationships, self-esteem, or daily life?
• Do I hide bald spots or avoid social situations?

If so, it's worth speaking with a therapist for hair pulling or a mental health provider experienced in CBT for trichotillomania.

Recognizing the symptoms

Recognizing the signs of trichotillomania is often the first step toward getting help. While the behavior may seem simple—pulling out hair—the surrounding emotions, triggers, and impact on daily life are more complex. Trichotillomania can manifest differently for everyone, but there are several common features to watch for.

Typical symptoms include:

• Recurrent hair pulling that leads to noticeable hair loss (from the scalp, eyebrows, eyelashes, arms, or other areas)
• Strong urges or tension before pulling, followed by a sense of relief or satisfaction
• Failed attempts to stop or reduce the behavior, despite a desire to do so
• Rituals around pulling, such as selecting certain hairs, pulling in a specific way, or examining the pulled hair
• Emotional consequences, including shame, guilt, frustration, and embarrassment
• Social withdrawal, especially to hide bald patches or avoid questions
• Skin damage or scarring, especially if pulling is frequent or aggressive

Some individuals may pull consciously (focused pulling)—often in response to stress or specific thoughts—while others do it automatically (automatic pulling) during passive activities like watching TV, reading, or thinking.

Because the behavior may not always be noticeable to others, many people with trichotillomania suffer in silence for years before seeking help. A qualified therapist for hair pulling can help distinguish between habitual grooming and a diagnosable condition.

If you or someone you know is experiencing these symptoms, it’s time to explore therapy for hair pulling or CBT for trichotillomania with a mental health professional.

What do the diagnostic criteria mean?

According to the DSM-5, the criteria for trichotillomania include:

• Recurrent hair pulling resulting in hair loss
• Repeated efforts to stop the behavior
• Significant distress or impairment in social, occupational, or other areas
• The behavior is not due to another medical or mental condition

These criteria help differentiate trichotillomania from other hair loss conditions or disorders. A trichotillomania psychologist can guide you through the evaluation and diagnosis process.

Getting diagnosed

Getting a diagnosis can feel intimidating, but it’s a vital step toward healing. Start by speaking with a therapist for trichotillomania or a psychologist familiar with body-focused repetitive behaviors. Diagnosis typically involves:

• A clinical interview
• Reviewing your behavior history
• Rule-outs for medical causes (e.g., alopecia, thyroid issues)

A clear diagnosis allows you to pursue the right treatment for hair pulling disorder, which often includes behavioral therapy, support, and lifestyle changes.

Hair pulling in trichotillomania isn’t random—it often serves a psychological or emotional purpose. People pull for a variety of reasons, and understanding the underlying “why” is essential to creating an effective treatment plan.

Here are some of the most common reasons people report:

• To relieve anxiety: Pulling can provide a temporary escape from feelings of overwhelm, panic, or stress.
• To manage boredom: For some, hair pulling happens when they’re understimulated or need something to do with their hands or mind.
• To release tension: In the lead-up to pulling, many report a sense of building discomfort that is temporarily alleviated by the act.
• To experience satisfaction or pleasure: Pulling may result in a brief sense of gratification or control, even though it’s followed by guilt or regret.
• As a coping mechanism: It may function as a form of self-regulation, especially for individuals who have difficulty expressing or processing emotions.

The behavior can be conscious or unconscious, and many people switch between these states throughout the day or depending on their environment.

While hair pulling may provide momentary relief, it’s ultimately a maladaptive coping strategy that can cause emotional and physical harm. Working with a BFRB therapist or trichotillomania psychologist helps clients build healthier, more sustainable ways to manage emotional discomfort.

There’s no single cause of trichotillomania. It’s believed to stem from a combination of:

• Genetic predisposition
• Neurobiological factors, including how the brain processes reward and impulse control
• Environmental influences like stress or childhood experiences
• Trauma or abuse, although many people with trichotillomania have no trauma history

The bottom line? You didn’t cause this, and you’re not alone. A trained trichotillomania specialist can work with you to explore contributing factors and create a path forward.

Effective treatment is possible—and usually involves a combination of approaches:

Behavioral Therapies

• Cognitive Behavioral Therapy (CBT) with Habit Reversal Training (HRT) is the gold standard.
• Acceptance and Commitment Therapy (ACT) helps manage urges without acting on them.

Psychoeducation

Learning about the condition helps reduce shame and builds self-awareness.

Environmental Strategies

Using fidget tools, keeping hands busy, or modifying your environment (e.g., covering mirrors) can help reduce pulling.

Medication Some people benefit from SSRIs or other medications to help manage urges and underlying anxiety or depression.

EMDR for Trichotillomania If trauma is a factor, EMDR therapy can be beneficial for processing unresolved experiences that may contribute to the behavior.

A well-rounded treatment plan, especially when guided by a body-focused repetitive behavior therapist, can lead to lasting improvement.

Look for professionals with experience in treating BFRBs. This may include:

• Trichotillomania therapists (LPCs, LCSWs, psychologists)
• CBT specialists trained in HRT and ACT
• Providers offering online therapy for trichotillomania
• Clinicians with trauma training who incorporate EMDR

Use directories like bfrb.org to find a trichotillomania specialist in your area.

Yes, unfortunately, trichotillomania can lead to long-term or even permanent damage if left untreated. The extent of the damage depends on the duration, frequency, and intensity of the hair-pulling behavior, as well as the area affected.

Here are some of the possible long-term consequences:

• Permanent hair loss: Repeated trauma to hair follicles—particularly on the scalp, eyebrows, or eyelashes—can result in scarring (traction alopecia), making regrowth impossible.
• Skin damage: Persistent pulling may lead to abrasions, sores, or scarring, especially if accompanied by picking or rubbing the skin around the hair.
• Infections: Open wounds and exposed hair follicles can become inflamed or infected, particularly if hygiene is compromised.
• Eye irritation or vision issues: For individuals who pull eyelashes, the absence of lashes can lead to debris entering the eye, increased light sensitivity, or even minor eye injuries.
• Digestive complications: In rare cases, individuals may ingest the pulled hair (a condition called trichophagia), leading to hairballs (trichobezoars) in the digestive tract, which can require surgery.

In addition to physical effects, the psychological toll can be significant. People may struggle with:

• Low self-esteem
• Body image issues
• Anxiety and depression
• Avoidance of social, professional, or romantic relationships

The sooner someone seeks help for trichotillomania, the more likely it is that the behavior can be managed, and potential damage can be minimized. With appropriate treatment—such as cognitive behavioral therapy for trichotillomania, medications, and supportive tools—many individuals see significant improvement and even full recovery.

Support is crucial. You don’t have to face this alone. Helpful resources include:

• The TLC Foundation for Body-Focused Repetitive Behaviors (bfrb.org)
• Online forums and virtual support groups
• In-person community meetups
• Peer-led education and advocacy groups

Connecting with others who understand can be a powerful part of healing.

While both involve physical harm, the intentions are different:

• Self-harm (like cutting) is often done to express or escape emotional pain.
• Trichotillomania is more about soothing, regulating stress, or automatic response—not a desire to cause harm.

Understanding this difference helps tailor the right treatment approach.

Trichotillomania and OCD share similarities, such as:

• Repetitive behaviors
• Difficulty resisting urges

But they differ in key ways:

• OCD behaviors are usually tied to fears or obsessions (e.g., fear of contamination)
• Trichotillomania behaviors are more impulse-driven and often occur without specific fears

Still, both can coexist, and a trained trichotillomania psychologist can help clarify your diagnosis and treatment plan.

No—it’s far more than a habit. While it may begin with repetitive behavior, trichotillomania is a mental health condition. It’s not about willpower or laziness. Left untreated, it can cause significant physical and emotional harm.

Real recovery comes from targeted treatment for hair pulling disorder, not self-blame.

Not at all. People may pull from:

• Eyelashes
• Eyebrows
• Arms, legs, and pubic area
• Facial hair (beard or mustache)

Some focus on one area; others alternate. The specific site may change over time, and multiple sites are often involved.

Trichotillomania is part of a family of behaviors called BFRBs, which also includes:

• Dermatillomania (skin picking)
• Onychophagia (nail biting)
• Lip or cheek biting

All BFRBs involve repeated grooming behaviors that can cause damage. Many people experience more than one. A body-focused repetitive behavior therapist can help address these behaviors holistically.