What Is Trichotillomania? Understanding and Treating Hair Pulling Disorder

What Is Hair Pulling Disorder?

Hair Pulling Disorder, also called Trichotillomania, is a condition that involves repeatedly pulling out your own hair. The pulling is often difficult to control and can lead to noticeable hair loss, thinning, or bald spots.

Hair pulling doesn't always focus on the top of the head. Many people pull from their eyebrows, eyelashes, facial hair, or other regions of their body as well.

Sometimes people may occasionally play with, twist, or pull at their hair. This does not automatically mean they have Trichotillomania. There are many reasons we might play with or tug at our hair.

To be diagnosed with Hair Pulling Disorder, it must cause you significant distress, interfere with your daily life, and result in damage to your body. In addition, people with Trichotillomania often make repeated attempts to stop pulling but find themselves returning to the behavior.

Why Do I Pull Out My Hair?

For many individuals, hair pulling starts with an urge. You may notice a hair that feels different, experience tension in your body, or feel a strong desire to pull. Once the hair is removed, you might experience relief, satisfaction, pleasure, or a sense that something now feels "right." Unfortunately, these feelings reinforce the behavior and make it more likely to happen again in the future.

I've worked with many clients who describe knowing they don't want to keep pulling, yet feeling drawn back to it over and over again. This can be confusing and frustrating, especially when the pulling leads to visible hair loss or feelings of embarrassment.

What If I Eat the Hair After Pulling?

Another behavior that can occur alongside hair pulling is eating the hair after it has been pulled. This is more common than many people realize.

While it may seem harmless, swallowing hair can sometimes lead to the formation of hairballs in the digestive system called trichobezoars. These can cause serious gastrointestinal problems and may require medical treatment. It is important to notify your therapist and medical provider immediately if this is a behavior you do.

The good news is that Hair Pulling Disorder is treatable. Understanding why the pulling happens is the first step toward learning how to manage it more effectively.

Is Hair Pulling Part of OCD?

This is another common question I hear from clients. The answer is: sometimes. Hair pulling can be a compulsion, but not all hair pulling is related to OCD. The key is understanding why the pulling is happening.

When Hair Pulling Is a Compulsion

For individuals with OCD, hair pulling may occur after having an intrusive thought that brings anxiety. For example, someone might have intrusive thoughts that a hair feels "wrong," fear that something bad will happen if they don't remove a certain hair, or experience a strong need for things to feel "just right."

They then pull the hair to reduce the anxiety or discomfort caused by the obsession. In these situations, the hair pulling functions as a compulsion. The purpose is to reduce anxiety, gain certainty, or prevent a feared outcome.

When Hair Pulling Happens More Automatically

For other individuals, hair pulling may happen more automatically or because of an urge. Some people notice themselves pulling when they are stressed, anxious, bored, tired, or concentrating on something else.

Others become focused on the texture, thickness, or feeling of certain hairs and feel compelled to remove them. Many clients describe scanning for hairs that feel different from the rest. Once they find one, they feel like they can't move on until they pull it out. Sometimes scanning for or pulling hairs can happen mindlessly while watching TV or scrolling on your phone.

While the behavior may look similar from the outside, the reason behind the pulling helps determine whether OCD is involved.

How Can I Stop Pulling My Hair?

The good news is that treatment is available and can be very effective. One of the most common treatments for Hair Pulling Disorder is Habit Reversal Training (HRT). Habit Reversal Training helps individuals better understand their pulling behaviors and develop healthier ways of responding to urges. Treatment often includes several components.

Building Awareness of When You Pull

First, we work on increasing awareness of when the hair pulling is happening. Many people are surprised by how often they pull without fully realizing it. Some may notice they pull while watching television, reading, scrolling on their phone, or working at their computer.

Finding Alternative Behaviors

Next, we identify alternative behaviors that can be used when urges show up. These replacement behaviors give your hands something else to do instead of pulling. The goal is not to simply sit with your hands in your lap all day, but to find realistic alternatives that fit into your daily life.

Understanding the Function of the Pulling

Treatment also focuses on understanding the function of the hair pulling. Is it helping you manage stress? Does it happen when you are bored? Are you trying to get rid of hairs that don't feel right? Understanding why the pulling occurs helps us identify additional skills that may be needed.

Making Changes to Your Environment

Finally, we often use stimulus control strategies. This involves making changes to your environment that reduce opportunities to pull. Examples might include wearing gloves, covering mirrors, putting your hair up, keeping fidget items nearby, or identifying situations where pulling is most likely to occur.

The goal is not simply to force yourself to stop pulling your hair. Instead, we want to understand what keeps the behavior going and teach your brain new ways to respond when urges show up.

For individuals who pull hair as a result of OCD, there is also an effective treatment for this called ERP. We have therapists trained in both of these therapies who are ready to help you reach your goal of reducing hair pulling.

Ready to Stop Pulling Your Hair? Start Online Therapy in Missouri

If you've been trying to stop on your own and keep finding yourself back at it, you're not failing. Hair pulling is hard to manage alone, and that's exactly why treatments like Habit Reversal Training and ERP exist.

You don't have to keep white-knuckling this by yourself. With the right support, you can understand what's driving the pulling and teach your brain a new way to respond.

I offer online counseling to people all over Missouri, so you can get specialized help with hair pulling from the comfort of your own home. Whether your pulling is tied to OCD or happens more automatically, we'll figure out together what's keeping it going and build a plan that fits your real life.

To get started, reach out to Aspire Counseling online or call us at 573-328-2288. We'll talk with you about what you've been experiencing and what you're looking for in a therapist. Then we'll set you up with a free consultation. Whenever you're ready for effective care and lasting change, we're here.

About the Author

Mikayla Wichern (LCSW) is an online therapist at Aspire Counseling who specializes in OCD and related conditions, including Hair Pulling Disorder (Trichotillomania). She's trained in Exposure and Response Prevention (ERP), the gold-standard, evidence-based treatment for OCD, as well as Habit Reversal Training (HRT) for body-focused repetitive behaviors like hair pulling and skin picking.

Mikayla works with adults of all ages on OCD, anxiety, trauma and PTSD, stress, and life transitions. She meets clients entirely online, which means she can work with anyone living anywhere in the state of Missouri. Clients often describe her as warm, down-to-earth, and genuinely invested in their progress.

When she's not seeing clients, you'll probably find Mikayla hanging out with her dog.

If you live in Missouri and you're ready to get help with hair pulling or OCD, Mikayla would love to help. Reach out online or call 573-328-2288 to get started.