A Hair Pulling Disorder

Overview

Hair-pulling disorder, also called trichotillomania, is a mental health condition where a person strongly feels the urge to pull out hair from their scalp, eyebrows, or other parts of the body. It's not a bad habit or a sign of weakness. It is a recognised condition that can be treated.

Yes, it's more common than many people think. Around 1 to 2 in 100 people will experience it at some point in their lives.

Hair-pulling disorder can affect anyone at any age. It often starts in the early teenage years, and it tends to be more common in females, but males can have it too.

Symptoms

Common symptoms

• Repeatedly pulling out hair from the scalp, eyebrows, or other areas
• Feeling a strong urge to pull, followed by tension that is relieved after pulling
• Visible bald patches, thinning hair, or missing eyelashes and brows
• Playing with or chewing the pulled-out hair
• Trying to stop or hide the problem, sometimes without success

Symptoms in children

• Pulling may happen during quiet activities like watching TV or falling asleep
• Children may not realise they are doing it
• They may also swallow the hair, which can cause tummy problems

Symptoms in older adults

• The behaviour may be more hidden, making it harder for family members to notice
• Hair loss often affects the scalp, beard area, or body hair
• Older adults might feel more ashamed or embarrassed and avoid social activities

Causes

Main causes

• The exact cause is not fully understood. It is likely a mix of genetics, brain chemistry, and emotional factors.
• Some people use pulling to manage stress, anxiety, or frustration.
• For others, pulling happens automatically, without any clear trigger.

Risk factors

• Having a family member with hair-pulling or a similar condition
• Long-term stress or high levels of anxiety
• Perfectionist tendencies or difficulty coping with strong emotions
• Having another mental health condition such as depression or obsessive-compulsive disorder (OCD)

When to see a doctor

See a doctor urgently if:

• See urgent care if you have severe pain, heavy bleeding, or a wound that looks infected at the site of hair pulling.
• If you have been swallowing hair and have constant tummy pain or vomiting, get medical help the same day.

Book a routine appointment if:

• Make a routine appointment if hair pulling is causing visible hair loss, distress, or is affecting your work, school, or relationships.
• Also talk to your doctor if you or your child are pulling hair and would like help to reduce it.

Diagnosis

Your doctor will ask about your hair-pulling habits, your feelings before and after pulling, and how it affects your daily life. They will also look at the affected areas to rule out other causes of hair loss, such as skin problems or infections.

Tests that may be done

• There is usually no blood test or scan needed.
• Your doctor may look at your scalp with a bright light and magnifier.
• They may ask you a few standard questions about your habits and moods.

What to expect at your appointment

The appointment is private and confidential. Your doctor might ask personal questions about your routines, stress, and emotions. This is normal and helps them to understand your situation so they can suggest the best next steps.

Treatment

Treatment for hair-pulling disorder focuses on understanding the habit and finding healthier ways to manage urges. Talking therapies are often the first recommendation. Your care team will work at your pace and make sure you feel supported.

Self-care at home

• Keep a simple diary to notice when and where you tend to pull hair.
• Wear gloves, keep your nails short, or cover your hair to add a small barrier.
• Use a stress ball, fidget toy, or textured object to keep your hands busy.
• Learn a short relaxation exercise, such as slow breathing, to use when urges feel strong.
• Be kind to yourself. Change happens gradually, and every small step counts.

Medical treatments

Some people may be offered a specific talking therapy called habit reversal training, or cognitive behavioural therapy (CBT). If your doctor thinks medicine could help with urges or related anxiety, they will prescribe something that is suitable for you and monitor it carefully. Never change or stop any prescribed medicine without talking to your doctor.

When is surgery considered?

Surgery is not used to treat hair-pulling disorder itself. It is only considered in rare cases to repair damage caused by repeated pulling, such as significant scarring, and this is never the first option.

Living with this condition

Living with a hair-pulling disorder can feel frustrating, but you are not alone. It can help to tell someone you trust and to keep a steady daily routine. Be patient with yourself, and celebrate small successes.

Lifestyle tips

• Try to get regular sleep and rest to reduce stress.
• Build in time for hobbies that keep your hands busy, like drawing, knitting, or playing an instrument.
• Move your body in ways you enjoy, such as walking, cycling, or dancing.

Diet and exercise

There is no special diet to stop hair pulling. Eating regular, balanced meals and staying physically active helps you feel steadier and more in control of your mood.

Mental health and emotional wellbeing

Hair pulling often causes shame, embarrassment, or anxiety. These feelings are real and deserve support. Talking to a counsellor or mental health professional can help you work through these emotions and build healthier coping strategies.

Prevention

It may not always be possible to prevent hair-pulling disorder from developing, but early support can stop the habit from becoming deeply embedded. Learning simple stress-management skills and becoming aware of early urges can help.

Complications

If left untreated

• Visible patchy hair loss that can affect confidence and social life
• Sores, scabs, or infections on the scalp, skin, or hands if pulling becomes forceful or uses tools
• Tummy pain, digestive blockages, or dental damage if hair is swallowed or chewed
• Increased anxiety, depression, or withdrawal from daily activities

Long-term outlook

There is good reason for hope. With the right treatment and support, many people greatly reduce their hair pulling or stop completely. Recovery can take time, but you deserve kindness and compassion along the way.

Find support

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