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Trichotillomania: Definition, Types, Symptoms, and Treatment

Trichotillomania is a hair pulling disorder. People cannot resist the urge to pull out their hair and harm the hair follicles by traumatizing them. The irresistible urge to pull out hair as a result of a trigger, psychological situation, or genetic factor may cause baldness in individuals if it is not treated early. 

✅Research shows that 1 or 2 out of 50 people suffer from trichotillomania.

✅In adults, 80–90% of these reported cases turned out to be women.

The key points of this article are:


Let’s learn all the details about trichotillomania.

What Is Trichotillomania?

Trichotillomania (TTM) is a mental condition in which an individual cannot resist the urge of pulling hair out. People feel a sense of tension before pulling out hair, and after this action in a hair-pulling disorder, they feel a sense of relief.

We can also call it chronic hair pulling because it is a long-lasting and recurring hair pulling disorder.

As a result of not being able to resist the urge and the act of pulling hair out, the person experiences noticeable hair loss, and even baldness occurs on the scalp as a result of hair pulled from scalp or in areas such as body hair, eyelashes, and eyebrows. This hair plucking habit also harms the hair follicles. 

💭The term ‘’Trichotillomania’’ was first introduced by French dermatologist François Henri Hallopeau (1842–1919) in 1889. He combined three words: ‘’Tricho (Hair) – Tillo (Pulling) – Mania (Behavior).

hair pulling disorder

How Common Is Trichotillomania?

Trichotillomania is a common disorder. 

⚠️ While the lifetime prevalence of trichotillomania was 0.6%, an increase in prevalence rates was observed if full symptom criteria were not met. While this rate was 3.4% for women, it was 1.5% for men.

However, individuals experiencing this disorder often do not tell anyone about it and do not seek help from a professional because they are ashamed. Thus, there are patients who cannot be diagnosed from chronic hair pulling.

Since the 19th century, many studies have been carried out about trichotillomania, which has taken place in medicine. In light of these studies, it was determined that the disease is common. 

In addition, the prevalence rate in different parts of the body varies. The scalp is where this problem is most common. Trichotillomania scalp picking is the most common case that we come across. The scalp is followed by the eyebrows, eyelashes, and pubic area. Pulling eyebrows out and ripping out eyelashes are parts of trichotillomania. 

Is Trichotillomania Genetic?

Yes, trichotillomania can be genetic.

Research and observations show that if an individual’s first-degree relatives have trichotillomania, it also develops in the people themselves. It shows that there is a genetic predisposition and there is a possibility of the disease starting. For example, if one of the twins has this pulling hair disorder, it can also occur in the other.

Is It Bad to Pull Out Hair?

Yes, it is bad pulling out hair because of the consequences. People can have bald spots from pulling hair and baldness in the pulled-out area can become permanent because hair does not grow as the hair follicles are severely affected and infected. 

Pulling hair out causes scarring, irritation and infection to your scalp. That’s why hair follicles are severely affected. Also, because of the inflammation, hair follicle parasites can occur. 

People with trichotillomania also can have trichotillomania hair follicle parasite. Scalp and hair damage are mostly seen in those who have hair picking disorder.

Trichotillomania is sometimes confused with Traction Alopecia which also includes pulling. However, the most lucid difference is in Trichotillomania the hair is pulled out from the follicle and traumatizes the scalp. 

Is Hair Pulling Disorder Contagious?

No, Trichotillomania is not contagious. There is no such thing as spreading to other people. It only affects the individual.

2 Types of Trichotillomania

Trichotillomania, which causes an uncontrolled pulling hair problem, has two more types:

  • Automatic Trichotillomania 
  • Focused Trichotillomania


Let’s go into the details of the two now.

Automatic Trichotillomania

Individuals with automatic trichotillomania pull their hair purely as a reflex, and they are absolutely unaware of it. They find themselves pulling out hair without realizing it or having any such intention. This is called automatic hair pulling

We can definitely say that the formation of this type is the result of psychological and emotional triggering. This action, which is done involuntarily as a result of being triggered, gives the individual an incredible sense of satisfaction.

There are also two subtypes of automatic trichotillomania:

  • High Auto – Low Focused
  • High Auto – High Focused
  • Low Auto – Low Focused


☑️ High auto stands for high-level automaticity, meaning it’s not consciously done. It’s almost like a habit.

☑️ Low focus stands for patients who are not strongly focused on hair pulling, it’s not their central focus to pull the hair.  

Focused Trichotillomania

Focus trichotillomania is the opposite of automatic trichotillomania. People deliberately pull out their hair. Again, in this pulling hair out action, which is done to get rid of the negative emotional state as a result of being triggered and to fight it, unlike automatic trichotillomania, the person is quite aware of what they are doing. As a result, it provides a sense of self-satisfaction.

Focus trichotillomania also has three subtypes, which are:

  • High Focused -High Auto
  • High Focused – Low Auto
  • Low Auto- Low Focused


☑️ High-focused stands for patients’ being aware of their hair pulling. This means their action is intentional. 

☑️ Low Auto stands for the behavior of pulling hair that is not done automatically. It’s not like a reflex or habit.

What Are the Symptoms of Trichotillomania?

Of course, trichotillomania has certain symptoms. Let’s find out what the common trichotillomania symptoms are.



⚠️We must keep in mind that these symptoms do not occur in the same way for everyone and do not progress in the same way. 

Why Do I Pull My Hair Strand by Strand?

Although there is no clear answer as to ‘’why’’ hair is pulled out, cases have often been linked to mood and mental health.

The tense tension experienced before hair pulling and the feeling of relief that follows can give the patient a feeling of an instant cure for what emotion they are struggling with.

We can also say that some psychological disorders trigger trichotillomania. These psychological disorders mostly are  OCD, ADHD, autism, or anxiety.

The patient may have developed trichotillomania by resorting to hair pulling as a coping mechanism as a result of being triggered by any feeling or action.

What Are the Caused of Trichotillomania?

While there is no clear and definitive answer about what causes trichotillomania, research and studies are ongoing to reach a clear answer. However, even without a clear answer, there are some groupings about what motivates patients with trichotillomania to do so and the condition where you pull out hair, as evidenced by the reported cases.

We can list them as follows:

  • Genetic Factors: In the reported cases, people with a family history of TTM were found to be in the high-risk group for developing this disease.
  • Imbalance in Neurotransmitters: This problem can arise when neurotransmitters (serotonin, norepinephrine, and dopamine) degrade.
  • Psychological and Environmental Factors: This can appear as a defense mechanism in individuals experiencing stress, anxiety, depression, or OCD.
  • Body Dysmorphia: As a result of the individual’s defect in any case and focusing on themselves, TTM may also begin.

OCD: Obsessive-Compulsive Disorder

Compulsive hair-pulling disorder and obsessive-compulsive disorder share many similar characteristics because they both have the urge to perform repetitive movements. There is difficulty controlling both of them.

When a person who has OCD also starts pulling out hair, it can be understood that the person has OCD hair pulling.

Anxiety Disorder

Anxiety triggers Trichotillomania.

A person who has anxiety experiences incredible tension, fear, and stress. They need some coping mechanisms to cope with this anxiety and stress. This coping mechanism can come back to them as trichotillomania.

The satisfaction and relief they experience after pulling out their hair eliminates their anxiety and stress for a moment, and they start pulling their hair whenever they feel anxious or stressed. We can call this an anxiety hair-pulling disorder. 


Autistic individuals are individuals with sensory sensitivity who may need to comfort themselves with sensory satisfaction.

Hair-pulling can also become a relaxing situation for them.

These individuals often need routines and can make any movement a routine and do it regularly. Hair-pulling can also become a part of this routine. Since they also have high levels of anxiety, this may be an inevitable move for them.

ADHD: Attention Deficit Hyperactivity Disorder

ADHD is a neurodevelopmental disorder that includes inattention as well as hyperactivity and impulsivity. Patients have difficulty concentrating, may be constantly on the move, and act purely on impulse. So, Trichotillomania is not ADHD. However, it should not be forgotten that it is not impossible to have both at the same time.

⚠️ Important Note: If you think you experience one of the disorders that we mentioned above, you should consult a professional.

How Does Trichotillomania Affect Your Life?

Trichotillomania, also known as hair-pulling disorder, can affect you both emotionally and physically.

Here are the physical effects: 

  • Appearance: Permanent hair baldness, sparse eyebrows, and missing eyelashes.
  • Scarring: Irritation and wound formation where the hair is pulled out.
  • Trichophagia: The urge to eat the hair that was pulled because hair pulling triggers.


We can observe the Mental Effects as follows:

  • Poor Self-Image: Self-confidence problems due to their appearance
  • Social Isolation: Social Isolation due to self-confidence
  • Anxiety and Depression: Guilt creates anxiety and depression

How to Diagnose Trichotillomania

To diagnose trichotillomania, you need to consult a doctor. Your doctor will ask you some questions before examining your scalp. 

Let’s do a quick test. These questions will form an answer about the possibility of trichotillomania.

If your answers to these questions are ‘’YES’’, you should consider seeking professional help.

Is Trichotillomania the Same for Adults, Children, and Babies?

Yes, the behavior is the same in babies, children, and adults with Trichotillomania. The behavior itself does not change. This behavior occurs for almost the same reasons in all three groups such as anxiety, stress, depression, and coping mechanisms. However, it is more common in adults.




82% Women

29% with Anxiety Disorder


How to Stop Pulling Your Hair

If you find the right approach, you can get rid of Trichotillomania.

Let’s see some approaches.

✅ You need to find out what is triggering you.

It is useful to keep a diary or calendar, as it will be a source of motivation for you.

Wearing a wig or hat is another effective way to shield yourself from your own hair. As a result, even if you reach for your hair, you will not find it.

Also, keeping your hands busy is another method of treatment. Stress relief toys keep your hands busy with your hair and can help you avoid hair-pulling.

It’s a disorder that has a lot to do with the subconscious, so treatments like hypnosis or other mindfulness techniques work.

How to Help Your Children with Trichotillomania

However, if you have a child with this disorder, these treatments and alternative treatments will differ. How should you treat trichotillomania in children? Let us discuss these.

✅First and foremost, it is critical to encourage the child to express their feelings. It is critical to determine why they tend to pull out their hair.

✅It is critical to be cautious and compassionate when conveying this communication. They should be able to convey whatever is going through their mind.

✅Behavioral therapy may be beneficial as well. It’s also a good idea to give them items that will keep their attention longer than their hair.

✅One of the most crucial factors is to maintain a stress-free and healthy home atmosphere. A healthy environment for the child ensures that the child grows up healthy.

✅You must be a good observer based on all of this. You should pay close attention to your child at all times and be aware when this need emerges.

Now that we’ve discussed the distinctions between what you and your child have, let’s look at the behavioral therapy, hypnotherapy, homeopathy, and home remedies discussed in this area.

Behavioral Therapy

Cognitive behavioral therapy (CBT), which is beneficial for treating Body-Focused Repetitive Behaviors, is also useful for trichotillomania treatment.

Behavioral Therapies focus on your thoughts about hair-pulling and how to avoid acting on those beliefs.

During the therapy session, you will gain a better understanding of trichotillomania and yourself. You will pay attention to your body. You will learn to transform this movement.

✅ A diary, as a habit reversal training, can be used to keep track of the hair-pulling behavior in habit reversal therapy, one sort of Behavioral Therapy. You will become more aware of how much you pull and what event or mood causes your pulling behavior. You will progressively be able to reverse the hair-pulling effect in this manner.


Hypnotherapy relaxes your subconscious mind, creates space for new thought patterns, and imbues you with good thoughts and behaviors.

It is critical in hypnotherapy, as in other treatments, to first comprehend the emotion linked with Trichotillomania. Then, in Hypnotherapy, which we call a trance state, the person who is doing Hypnotherapy breaks down the thought patterns in your brain that lead you to pull out your hair, replace them with good ones, and give subconscious instructions to demolish this tendency.

Medication Treatment: Homeopathy

In homeopathy, the doctor offers individualized treatment. The technique of self-healing by triggering the body is used. In homeopathy, highly diluted medicine is used to help the body improve itself. It does not eliminate the symptoms; it encourages the body to heal itself.

Home Remedy: Fidget Toys

Fidget toys provide sensory stimulation and are very suitable for trichotillomania. They are small, handheld toys that are used for sensory distraction. It takes attention away from the urge to pull hair and focuses it on itself. Thus, it removes the individual from this impulse completely.

Little spinning wheels and stress balls are examples of these toys. The choice of toys completely depends on the individual. Because it’s portable, it doesn’t matter when the urge comes. You immediately take it out of your bag or pocket, causing the impulse to go away from you.

The tiny toy in your hand draws all the attention of your mind to it.

Does Your Hair Grow Back After Trichotillomania?

Yes, hair growth is certainly possible after trichotillomania. Although the rate and speed of hair regrowth vary from person to person, we can say that, in most cases, hair grows back after trichotillomania with the right trichotillomania treatment.

But we can have a question in our mind: Can trichotillomania cause permanent hair loss? Having a permanent hair loss problem depends on several factors. But if you have these few factors, the hair problem can be permanent. We can list those factors as follows:


Trichotillomania Hair Regrowth Tips

We said that it is possible for hair to grow after Trichotillomania, which is a challenging and exhausting hair picking disorder. There are some tips for hair pulling treatment. 

Let’s examine it.


What Is the Best Medication for Trichotillomania?

There is no medicine that can be said to be the best medicine for trichotillomania treatment. We cannot say ‘’best’, but of course, there are drugs that can be good for hair pulling treatment. Here are five drug groups that can be used in trichotillomania treatment. 

  • SSRI


You should be examined by a professional to find the medicine that is right for you and will be best for you for hair pulling treatment.

Does Hair Transplant Work for Trichotillomania?

Yes, hair transplantation can be used as a trichotillomania treatment method., However, you need to answer no to these questions to understand whether you are a suitable candidate:

❓Do you still have the urge to pulling out hair?

❓Have you pulled out any hair in the last year?

❓Do you have burning, itching, or pain on your scalp?

❓Has there been any enlargement in the area where your hair is falling out?

❓Do you have any medical disorders?

❓Are you under 18?

If you responded  “no”, the hair transplant procedure will definitely work as a hair pulling treatment.

Tips to Talk with a Person Who Has Trichotillomania

Understanding, respect, and support are very important for individuals with trichotillomania, and the way you speak should be shaped accordingly. Let’s see some tips for talking.

➡️ Choose the right time

➡️ Don’t be judgmental

➡️ Avoid comparing with other problems

➡️ Avoid judgmental attitude 

➡️ Be attentive

➡️ Be a good listener

➡️ Be understanding

➡️ Make them talk

➡️ Stay patient

➡️ Talk supportively

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[4] Grant JE, Chamberlain SR. Automatic and focused hair pulling in trichotillomania: Valid and useful subtypes? Psychiatry Res. 2021 Dec;306:114269. doi: 10.1016/j.psychres.2021.114269. Epub 2021 Nov 2. PMID: 34758405; PMCID: PMC7612152.