Trichotillomania (Hair Pulling)

Also called: hair-pulling disorder, TTM, tric, hair pulling

Trichotillomania (pronounced: trik-eh-til-eh-MAY-nee-uh) is a strong habit that causes people to pull out their own hair. They may pull hairs from their scalp, eyebrows, eyelashes, or pubic area. People may pull out a few hairs at once or one strand at a time. Some may look at, play with, chew, or eat the hair after pulling it out.

Others may not understand why people who pull out their hair don’t just stop. But to people going through this, hair pulling can be a very hard habit to break. Even though they have tried to stop, hair pulling can feel impossible to control.

If you are dealing with hair pulling, you’re not alone. And there’s treatment that can help. It takes time, patience, and practice. But when they learn the right skills, people can overcome hair pulling.

What Is Trichotillomania (Hair Pulling)?

Hair pulling is a type of body-focused repetitive behavior (BFRB for short). BFRBs are self-grooming behaviors that become strong, unwanted habits.

There are different forms of BFRBs. For example, some people bite or chew their nails, lips, or the inside of their cheeks. Some pick their skin or nails. Some pull out, break off, twist off, or chew their hair. All these habits are BFRBs if a person does them to extreme.

BFRBs are not a type of self-harm. But they can cause damage to the hair, skin, or nails.

Can Trichotillomania Cause Health Problems?

Hair pulling can leave bald patches or areas without hair, eyebrows, or eyelashes. It can cause the skin to become sore or infected. It can leave scars. If people chew or swallow hair, it can cause a ‘ball’ of hair to form. This can lead to stomach pain or other health problems.

What Causes Trichotillomania (Hair Pulling)?

It’s not clear why some people do hair pulling but others don’t. Experts think that genes, hormones, and habit learning all play a role.

Genes. People who do hair pulling may have genes that make it more likely.

Hormones. Puberty hormones and stress hormones may prompt hair pulling to start in those who have the genes for it.

Habit learning. Many people with trichotillomania feel an itch, tingling, or an urge to do it. When they pull hair, they get a brief sense of relief. To the brain, this relief is a reward. The brain releases reward hormones, such as dopamine. This links hair pulling with the reward. It causes a hair-pulling habit to form.

Each time the person pulls hair, the brain releases a small burst of reward hormone. The person feels ‘rewarded’ with a brief sense of relief. This makes the urge harder to resist. Doing the habit makes it stronger.

What’s It Like for Someone With Trichotillomania?

Most people who do hair pulling feel stuck in a habit they don’t want. They may feel frustrated that they can’t control it. They may feel nagged by people who don't understand what it’s like for them. Some are hard on themselves for not being able to stop. But hair pulling is not their fault.

They may feel upset about how hair pulling affects their looks. Some may try to cover bald patches with hats or make up. Hair pulling can affect the way they feel around others, too. Some try to hide the hair pulling, even from family or friends. They might avoid doing things that could let others notice it.

What Can Help People With Trichotillomania (Hair Pulling)?

Therapy can help people overcome trichotillomania. The most widely used type of therapy is called habit-reversal training (HRT). It's a type of cognitive behavioral therapy (CBT). In this therapy, people meet with a therapist to learn skills to help them reverse the hair pulling habit.

Habit reversal is based on the way the brain learns habits. The same principles can help people unlearn a habit they don’t want.

To unlearn hair pulling, people need to resist the urge to pull hair. When they resist the urge, the reward hormone doesn’t get released. This breaks the cycle of hair pulling. Without the reward, the habit can start to fade on its own.

This sounds simple. But it’s not easy at first. The urge to pull hair can feel strong. It can be very hard to resist. Therapy is a way for people to build the skills that make it possible. With the right guidance — and plenty of practice — it gets easier. For this to work, people need to resist the urge to pull every time they feel it.

Along with habit reversal, other forms of therapy work for hair pulling. They include ComB (comprehensive behavior therapy), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT). Each of these forms of therapy offers skills people can use to work on trichotillomania.

It takes time, patience, and practice. But with the right guidance and support, people can overcome hair pulling.

What Should I Do if I’m Dealing With Trichotillomania?

Talk to an adult. If you're pulling your hair, talk about it with a parent, doctor, mental health counselor, or an adult you trust. It can be hard to talk about. But it’s best to be open and honest so that you can get the help you need.

Have a visit with your doctor. They will ask questions, listen, and talk with you and your parent. They will check for other things that can cause hair pulling or hair loss. If they diagnose trichotillomania, they can refer you to a therapist for treatment that can help.

Go to visits with a therapist. Therapy can take many visits. It takes time and practice to get good at the skills you’ll need. But you’ll notice progress along the way.

Let others support you. Support from loved ones helps a lot when you’re going through something like hair pulling. When you want to, it can feel good to confide in someone you trust. You can also feel their support when they do simple acts that show they care — or just by spending time together.

Do things to manage your stress. Stress doesn’t cause hair pulling. But stress can make it worse in people who have it. Be sure to eat foods that are good for you. Exercise and be active. Take time to rest, relax, or meditate. Make time for things you enjoy. Show kindness and help others. Doing these simple things every day helps keep stress levels in check.

The TLC Foundation for Body-Focused Repetitive Behaviors is a good resource for learning more as well as getting help and support.