Trichotillomania (TTM) is sometimes related to certain mental health conditions, such as anxiety and depression. While it may also start for other reasons, it is often cyclical. Treatments focus on the underlying emotions and behaviors.

We all deal with anxiety and stress in our own way. For people with trichotillomania, that may include an overwhelming urge to pull out your own hair. Over time, repeatedly pulling hair out can lead to bald spots and even more emotional distress.

Here, we’ll discuss the signs and symptoms of trichotillomania and ways to treat this condition.

Trichotillomania (TTM) is a mental disorder in which people feel an overwhelming need to pull out their own hair. Research suggests that 0.5 to 2 percent of people have TTM.

In childhood many people who experience trichotillomania will focus on pulling out the hair on their scalp, often focusing on just one or two areas; however, people with TTM do not always limit hair pulling to the scalp. They may pull hair from other areas like the eyebrows, eyelashes, or any other area on their body that has hair. Over time, this can lead to bald spots and thinning hair.

Trichotillomania usually develops during the adolescent years, but it’s been known to appear in young children, too. Once it starts, it can continue for several years through to adulthood. It affects males and females equally in childhood but can affect females more often during adulthood.

Some women report having more urges to pull out their hair during the start of their menstrual cycles. A small 2018 study suggests that the hormonal changes happening in a woman’s body during the start of their cycle may have an impact on symptoms of trichotillomania, but researchers aren’t sure why.

A 2013 case study suggests that symptoms of trichotillomania may be impacted by hormonal changes during pregnancy. However, more research is needed to support this.

Symptoms of trichotillomania include:

  • pulling out hair repeatedly
  • breaking off pieces of hair
  • eating hair (trichophagy)
  • feeling relieved after pulling hair out

Common areas for hair pulling include:

  • scalp
  • eyebrows
  • eyelashes
  • beards
  • pubic hair

Over time, those affected by trichotillomania may experience side effects like:

  • itching or tingling at the site where hair was pulled
  • bald spots
  • thinning hair
  • skin irritations
  • social anxiety

Researchers aren’t sure what causes trichotillomania. There may be a genetic reason why people develop it. Environmental factors may also play a role.

According to a 2016 study, the typical age for the symptoms to appear is between 10 and 13 years old. Symptoms usually start with pulling out the hairs on the scalp, which makes the person feel less anxious or stressed.

Many people don’t even notice themselves pulling their hair. The realization that they are pulling out hair can lead to more feelings of anxiety and embarrassment. This creates a cycle of anxiety, hair pulling, temporary relief then anxiety, embarrassment, and hair pulling again.

Trichotillomania is a mental health condition that is sometimes related to other conditions such as:

Not everyone who has these conditions will experience trichotillomania. Symptoms may start for many reasons, including:

  • enjoying feeling the thickness of hair on their fingers
  • enjoying feeling the sensation of pulling hair on the scalp
  • emotions like anxiety, boredom, anger, shame, or stress

Trichotillomania can affect children, adolescents, and adults of all genders. However, it tends to occur more often in women than men, with a ratio of 9 to 1.

Risk factors associated with developing trichotillomania can include:

  • having a mental health condition such as anxiety, OCD, or depression
  • being female
  • being an adolescent
  • experiencing a stressful situation

This condition is thought to be underreported.

To diagnose trichotillomania, a doctor will talk to you about your medical history, as well as symptoms you may be experiencing. They will likely use the criteria in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to see if your symptoms match up.

According to the DSM-5, someone diagnosed with trichotillomania must meet the following criteria:

  • recurrent pulling out of one’s hair, resulting in hair loss
  • repeated attempts to decrease or stop hair pulling
  • hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • hair pulling or hair loss that is not attributable to another medical condition (e.g., a dermatological condition)
  • hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)

The doctor will also rule out any other causes of hair loss and may send you to a dermatologist (skin doctor).

Finding help for trichotillomania

If you are experiencing symptoms of trichotillomania, you are not alone. Trichotillomania is diagnosed by a mental health professional. If you need help finding one or if someone you love has trichotillomania, the following resources may be able to help:

  • SAMHSA’s National Helpline. This helpline offers information and help in finding a mental health provider in your area.
  • National Alliance on Mental Illness (NAMI). NAMI provides advocacy, education, and support to individuals and families who are affected by mental illness.
  • The TLC Foundation. The TLC Foundation for Body-Focused Repetitive Behaviors is an organization offering support and education to those affected by trichotillomania and other related conditions.

Treatment of trichotillomania depends on the severity of the symptoms. A mental health professional may recommend the following:

Behavioral therapy

A 2014 study showed the benefits of habit reversal training (HRT) and stimulus control in treating TTM. HRT works by:

  • increasing a person’s awareness about TTM symptoms and triggers
  • replacing the hair pulling behavior with another behavior
  • finding ways to stay motivated to stop hair pulling behavior
  • practicing the new learned skills in different situations

Stimulus control works by:

  • identifying the situations and sensory factors that lead to pulling
  • reducing or eliminating those situations and sensory factors

Therapy focused on emotional regulation

A doctor or therapist may help you learn to manage the emotions, such as anxiety, fear, or sadness, that contribute to your urge to pull. Understanding and accepting these difficult emotions may help change your response to them.


Medications, including antidepressants and antipsychotics, may have an effect on trichotillomania:

  • N-acetylcysteine
  • olanzapine (Zyprexa)
  • clomipramine (Anafranil)
  • quetiapine (Seroquel)

Researchers did note that the clinical trials with these drugs had very small sample sizes. More studies are needed to support the results.

Trichotillomania can cause permanent hair loss and scarring. This is more common in people who continue to pull their hair out into adulthood.

Some people with trichotillomania may also eat their hair, a condition known as trichophagia. This may result in hair building up in the digestive tract and can also cause a dangerous obstruction.

Trichotillomania is often underdiagnosed. Those who have symptoms may feel embarrassed or afraid to talk to their doctor about what they are experiencing. Symptoms may affect a person for just a few months, while it may affect another person off and on for many years.

Many people report symptoms happening in cycles where hair pulling urges may happen often for a few months then go away completely for a little while.

If you think that your friend or loved one is experiencing symptoms of trichotillomania, it can be hard to know what to say. Here are some tips:

Avoid saying things like:

  • “Why don’t you just stop pulling your hair?” More than likely, your loved one asks themselves the same thing every day. Saying something like this may make their feelings of guilt and shame worse.
  • “Just find another way to deal with stress.” Chances are, they have likely tried to do this hundreds of times. Instead, talk to your loved one about what they are feeling and ask how you can best support them.
Was this helpful?

Say this instead:

  • “How can I help?” Whether it’s helping find an experienced healthcare professional, locating local support groups, or just listening, you can show that you’re there for them.
Was this helpful?

There is no one way to cure or prevent trichotillomania. However, treating the underlying negative emotions may help prevent the urge to pull your hair from coming back.

Reducing or relieving stress and finding outlets for it may help reduce the urge to pull your hair. You may also want to consider therapy for stress.

Trichotillomania affects many people all over the world and is considered a treatable mental health condition. There are many ways to manage it with therapy and medication.

If you or someone you know is experiencing these urges, reach out to your family doctor, mental health professional, or a trichotillomania support group.