Trichotillomania: when hair pulling is hard to stop

Some hair loss is caused by the person themselves, without them wanting it. Trichotillomania (often shortened to trich or TTM) is when someone cannot resist the urge to pull out their own hair ¹. It is a recognised condition, not vanity or weakness, and it can be treated.

What trichotillomania looks like

People with trich feel an intense urge to pull out hair, with growing tension until they do, followed by a sense of relief afterwards ¹. Pulling can happen:

• Without noticing, for example while watching television, reading, studying or talking on the phone ²
• On purpose, in response to urges, stress or anxiety, which the pulling eases for a while ²

Many people do both ². The scalp is the most common site, but hair can also be pulled from the eyebrows, eyelashes, beard, arms, legs or pubic area ^{2 1}.

Signs on the scalp

• Irregularly shaped patches of thinning or bald areas, which may feel stubbly, with hairs of different lengths ²
• Patches that affect one side of the head more than the other ¹. Children often pull from areas that are easy to reach on the same side as their dominant hand ²
• Missing or broken eyelashes and eyebrows ²
• Scratches, bruising or redness from picking ²

Who gets it?

DermNet estimates that trichotillomania affects up to 4% of the general population. It can affect anyone at any age, but is more common in children than adults ². The NHS says it usually starts between the ages of 10 and 13 ¹, and DermNet notes peaks in the pre-school years and around puberty ². In children it affects boys and girls equally, while in adults it is seen more often in women ².

If you are a parent, see also hair loss in teenagers.

Why does it happen?

The exact cause is not fully understood ^{2 1}. Possible factors include:

• A way of coping with stress or anxiety ¹
• Changes in the brain's chemistry, or hormone changes during puberty ¹
• A family tendency, as more than one person in a family may have it ¹
• Links with obsessive-compulsive disorder and other body-focused repetitive behaviours, such as nail biting, skin picking, lip biting and cheek chewing ²

For some people, the more they pull, the more they want to keep doing it ¹.

How it is diagnosed

A doctor or dermatologist will look at the hair loss pattern and ask about pulling. It is important to rule out other causes, especially alopecia areata, which can also cause patchy hair loss ². See alopecia areata. Tests may include:

• A hair pull test, which is usually negative in trich ²
• A Wood's lamp check to rule out a fungal infection ²
• Dermoscopy (a magnified scalp exam), which may show broken hairs of uneven length and split ends ²
• Sometimes a scalp biopsy ²

The NHS notes your GP may examine the areas of missing hair to check nothing else, such as a skin infection, is causing it ¹.

Treatment: habit reversal training

The main treatment is a type of cognitive behavioural therapy (CBT) called habit reversal training ¹. A 2025 expert review described these behavioural approaches as the most notable treatments found to be effective, while noting that relapse in adults appears to be somewhat common ³. Treatment usually involves ¹:

• Keeping a diary of when and where you pull
• Working out your triggers and learning how to avoid them
• Replacing pulling with a harmless action, such as squeezing a stress ball
• Support and encouragement from loved ones

For young children, DermNet says care is usually gentle and practical, such as keeping hair short, covering the hands with gloves or socks, and calm reminders. Many young children outgrow it ².

The NHS says antidepressants are not usually prescribed for trich ¹. DermNet notes that for difficult cases in teenagers and adults, a specialist may consider certain medicines ². The 2025 review says newer drug options look promising but need more research ³.

Things you can try when the urge comes

These tips come from people with trich, as collected by the NHS ¹:

• Squeeze a stress ball, or make a fist and tighten your arm muscles
• Use a fidget toy
• Wear a bandana or a close-fitting cap. For some women, a tudung may serve the same purpose
• Put plasters on your fingertips
• Practise deep breathing until the urge passes
• Exercise, or take a soothing bath to ease stress
• Cut your hair short

When to get help

See a doctor if you or your child are pulling out hair. Get help sooner if there is a habit of eating hair, as this can form hairballs in the stomach and lead to serious illness ¹. DermNet lists abdominal pain, nausea, vomiting and constipation as possible signs ².

Do not wait for the hair to "fix itself". Repeated pulling can damage follicles and may lead to irreversible scarring ². Early help gives the best chance of the hair recovering.

Living with trich

Trich can bring shame and low self-esteem, and many people hide it ¹. The NHS notes that hiding it can make anxiety worse, and that many people who manage their trich found that talking to others helped reduce pulling ¹. If shedding or patches are also making you anxious, see a calm first response to hair loss.

The bottom line

Trichotillomania is a common, treatable condition, not a character flaw. Habit reversal training is the main treatment, and support from family helps. Rule out other causes of patchy hair loss, get help early, and seek urgent advice if hair is being swallowed.

Frequently asked questions

Is trichotillomania just a bad habit?

No. It is a recognised condition where a person cannot resist the urge to pull out their hair ¹.

How common is trichotillomania?

DermNet estimates it affects up to 4% of the general population ².

What is the main treatment?

A type of CBT called habit reversal training ^{1 3}.

Will hair grow back after trichotillomania?

It often can, but repeated pulling can damage follicles and may cause irreversible scarring, so early help matters ².

Educational content. Not medical advice.