10 Things to Know About Trichotillomania

I’ve gotten a lot of questions these past few weeks about trichotillomania, so this week’s blog goes into the basics of the hair-pulling disorder. For more information, check out the Hair Loss section of my website; it discusses trichotillomania and other hair loss disorders in greater detail. As always, if y’all have any questions, leave a comment or message me and I’ll be happy to answer them!


1. What is trichotillomania?

Trichotillomania (trich for short), also called hair-pulling disorder, is characterized by the recurrent, irresistible urges to pull out one’s hair, despite trying to stop. Hair pulling has recently been classified as a Body-Focused Repetitive Behavior (BFRB), which includes self-grooming behaviors like nail biting and skin picking. 

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for diagnosing trichotillomania include:

  • Recurrent hair pulling, resulting in hair loss

  • Repeated attempts to decrease or stop the behavior

  • Clinically significant distress or impairment in social, occupational, or other area of functioning

  • Not due to substance abuse or a medical condition (e.g., dermatological condition)

  • Not better accounted for by another psychiatric disorder

2. How do you pronounce trichotillomania?

**I should've done spelling bees as a kid**

3. What causes trichotillomania?

There is no clear cause for trichotillomania; however, it’s believed to be a combination of genetic and environmental factors. Those who have a family member with trich are believed to be at a higher risk for developing the disorder. Other disorders like depression, anxiety, and Obsessive-Compulsive Disorder (OCD) have also been linked to trichotillomania, and may increase the risk of trichotillomania. 

4. How many people have trichotillomania?

Research from the TLC Foundation for Body-Focused Repetitive Behaviors indicates that about 1 or 2 in 50 people experience trichotillomania in their lifetime. The disorder usually begins in late childhood/early puberty. While the disorder occurs equally in boys and girls in childhood; by adulthood, 80-90% of reported cases are women.

5. Does everyone pull from the same spot?

No - People with trichotillomania pull from different areas. Hair pulling sites include the scalp, eyebrows, eyelashes, and/or body hair. Sites vary by person, and may even vary over time (ex. I used to pull from my eyebrows, but don’t anymore). Within sites, some spots may be more pleasurable than others (ex. I’ve pulled from the left side of my head for years, but find it painful to pull from the right side).

6. Does it hurt?

No - It feels so good! For those with trichotillomania, hair pulling gives a sense of pleasure and relief in the areas pulled. In fact, there is usually a sense of tension before hair pulling or when trying to resist the urge to pull.

7. Do you always know when you're pulling?

Not necessarily - Hair pulling can be focused or automatic. Focused hair pulling is intentionally pulling out hairs to relieve tension or urges. Automatic hair pulling is pulling without realizing what you’re doing. I used to only exhibit focused hair pulling, but now I can pull dozens of hairs before I realize what I’m doing. 

8. Do you pull your hair because you're stressed?

Sometimes - Because trichotillomania is linked to anxiety and other disorders, some people experience higher levels of pulling when stressed as a way of relieving any negative emotions. Hair pulling can also be purely pleasurable - some people pull just to experience the positive sensation.

9. Do you grow out of it?

There is no “cure” for trichotillomania. There are different types of therapy that are recommended for those with trich, namely Habit Reversal Therapy, Cognitive Therapy, and Acceptance and Commitment Therapy. However, like many mental disorders, with or without treatment trichotillomania tends to become a chronic condition that needs to be monitored throughout one’s life.

10. How do you talk to somebody about their trichotillomania?

Hair pulling causes a lot of shame and embarrassment. Regardless of how open someone may seem about their trich, they may not always be comfortable discussing their disorder. Don’t approach trichotillomania like a problem that needs to be fixed; statements like “you’re too old for that” or “I wish you would stop pulling” are not helpful. Trust me, if we could stop pulling, we would. Rather, let them know that you support them wherever they are on their journey with trichotillomania, and that you appreciate them regardless of whether or not they pull their hair.