Trichotillomania (hair pulling)

Last updated: 6 February 2026. Next review: 6 February 2027

What is trichotillomania?

Trichotillomania is a condition characterised by a compulsive urge to pull out one’s own hair, which can lead to noticeable hair loss and emotional distress. Trichotillomania is a body-focused repetitive behaviour (BFRB).

There are several forms of trichotillomania:

Focused hair pulling – intentional pulling, often following specific rituals, such as targeting certain types of hair
Automatic hair pulling – hair is pulled without full awareness
Mixed hair pulling – a combination of focused and automatic pulling

Trichotillomania is most frequently seen in children, teenagers and young adults. While it happens in both sexes, it is more commonly reported in females than in males.

Symptoms of trichotillomania

Symptoms of trichotillomania can include patchy bald spots, often uneven in shape and pronounced on one side of the scalp.

Hair may also be pulled from:

Eyebrows
Eyelashes
Pubic hair
Beard or moustache

Hair pulling can cause emotional distress, affect social interactions, or interfere with work or school. Severity varies; some people experience mild, manageable symptoms, while others struggle with chronic hair loss.

Causes of trichotillomania

The exact cause is unclear, but several factors may increase risk:

Genetic predisposition – it can be seen in families with a history of the condition
Age of onset – it typically develops before or during early teens (ages 10–13), possibly triggered by changes in hormone levels during puberty
Coexisting conditions – including anxiety, depression, or obsessive-compulsive disorder (OCD)
Stressful events – may trigger hair-pulling behaviour in some individuals

Can trichotillomania result in other symptoms?

Yes, chronic hair pulling can lead to:

Scarring and damage to hair follicles, sometimes causing permanent hair loss
Skin infections at sites of frequent hair pulling
Trichophagia – when individuals eat the hair they pull out, potentially leading to hairballs and serious digestive problems. (If you or someone you know is eating hair, it is important to seek medical advice promptly)
Shame and psychological distress

Can trichotillomania be treated?

The most effective treatments focus on behavioural and psychological therapy, including:

Cognitive Behavioural Therapy (CBT) – helps individuals recognise triggers and change hair-pulling behaviours
Acceptance and Commitment Therapy (ACT) – supports coping strategies and emotional regulation

Research shows behavioural therapy is more effective than medication in most cases, though some patients may also benefit from supportive medications under a doctor’s supervision.

Additional information:

BFRB UK & Ireland is a charitable organisation for Body-Focused Repetitive Behaviours (BFRBs), including hair pulling, skin picking and nail biting. BFRB UK & Ireland have support groups, a Facebook group and a mailing list.

VISIT the BFRB UK & IRELAND WEBSITE

Anxiety UK have some useful information about trichotillomania

VISIT THE ANXIETY UK WEBSITE

Trichotillomania Support has a website where you can get advice and support from other people affected by the condition. They also have information on treatments and self-help advice.

VISIT THE TRICHOTILLOMANIA SUPPORT WEBSITE

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