Trichotillomania is a body-focused repetitive behavior that affects 1–2% of the population. If you pull your hair and feel unable to stop, you are not alone—and evidence-based approaches can help. This page explains what trichotillomania is, what causes it, how it affects your life, and how CBT-based treatment works.
Trichotillomania (trik-oh-til-oh-MAY-nee-uh), also called hair-pulling disorder, is a mental health condition in which a person feels a recurring, irresistible urge to pull out their own hair. It is classified in the DSM-5 as an Obsessive-Compulsive and Related Disorder and belongs to a group of conditions known as Body-Focused Repetitive Behaviors (BFRBs).
BFRBs are repetitive self-grooming behaviors—including hair pulling, skin picking, and nail biting—that cause noticeable physical damage and significant emotional distress. Among these, trichotillomania is one of the most common and most studied.
Learn the CBT foundations that help thousands break the hair-pulling cycle—for free.
Start Free Mini-CourseTrichotillomania does not have a single cause. Research suggests it arises from a combination of neurobiological, genetic, and environmental factors. Understanding these can reduce self-blame and point toward effective treatment.
Brain imaging studies show differences in regions involved in habit formation, impulse control, and emotion regulation. The cortico-striato-thalamo-cortical (CSTC) circuit—which governs habitual behaviors—appears to function differently in people with trichotillomania. Imbalances in serotonin, dopamine, and glutamate neurotransmitter systems may also play a role.
Trichotillomania runs in families. First-degree relatives of people with the condition are significantly more likely to develop it or a related BFRB. Twin studies support a heritable component, although no single gene has been identified.
Emotional states frequently trigger or intensify hair pulling. The most common triggers include:
Many people with trichotillomania describe specific sensory experiences connected to pulling—feeling a hair that seems "different," the tactile sensation of pulling, or visual inspection of the root. These sensory components create a self-reinforcing loop that maintains the behavior.
Trichotillomania presents differently from person to person, but common patterns include:
Trichotillomania reaches far beyond hair loss. The condition can profoundly affect emotional well-being, relationships, and daily functioning.
Shame, guilt, and self-blame are nearly universal. Many people feel "broken" or "out of control." Anxiety and depression frequently co-occur, sometimes as a result of the pulling itself.
Fear of discovery leads to avoiding social events, canceling plans, and pulling back from relationships. Many people with trich feel deeply isolated—believing no one would understand.
Visible hair loss can damage self-image and confidence. People often feel defined by the behavior, losing sight of their strengths and identity beyond trich.
Pulling episodes, concealment routines, and the mental energy spent fighting urges can consume hours every day—taking time away from work, hobbies, and relationships.
Over 6,000 students have started their recovery with evidence-based CBT tools. The first week is free.
Learn More →Trichotillomania is treatable. While there is no overnight fix, several evidence-based approaches have strong track records—and they can be combined for the best results.
The most studied and effective behavioral treatment for hair pulling. HRT teaches you to recognize triggers, build awareness of pulling urges, and practice competing responses until the habit is replaced. Research consistently shows HRT reduces pulling frequency and severity.
A broader approach that adds stimulus control (changing your environment), sensory substitution, and cognitive-emotional strategies to traditional HRT. ComB addresses the multiple functions pulling serves—relief, stimulation, and emotional regulation.
N-acetylcysteine (NAC) has shown promise in some studies. SSRIs may help when anxiety or depression co-occurs. Structured self-help programs—especially those based on CBT—provide accessible tools for people who prefer to learn at their own pace.
Dr. Ohad's 12-week course teaches the cognitive, emotional, and behavioral skills that target the patterns behind hair-pulling.
Explore the CourseCognitive Behavioral Therapy (CBT) is the first-line treatment for trichotillomania because it directly targets the thoughts, emotions, and behaviors that maintain the pulling habit. Here is how CBT works for hair pulling, step by step.
The first step is noticing when, where, and how you pull. Many pulling episodes happen on autopilot. Awareness training helps you catch the urge early—before the hand reaches the hair—by tracking triggers, body positions, emotional states, and situational cues.
Once you can identify the urge, you learn to replace pulling with a competing action—such as clenching your fist, pressing your hands flat, or holding an object. The key is choosing a response that is physically incompatible with pulling and holding it until the urge passes.
This involves changing the environment to reduce pulling opportunities and triggers. Examples include wearing gloves during high-risk activities, changing lighting, rearranging your workspace, or using fidget tools—anything that creates a barrier between the urge and the behavior.
Pulling is often driven by low tolerance for stress, boredom, anxiety, or frustration. CBT teaches you to sit with uncomfortable feelings without acting on them—to let urges rise, peak, and naturally fade. This builds the emotional resilience that makes lasting change possible.
Dr. Ohad's course uses a transdiagnostic protocol that goes beyond standard HRT. Rather than only targeting pulling behavior, it addresses the underlying emotional habits that drive it: stress-inducing thoughts, low distress tolerance, and avoidance patterns. This means the skills you learn generalize to other areas of life—reducing anxiety, improving self-esteem, and building healthier emotional responses overall.
I took Dr. Ohad's course and haven't pulled since—thorough and useful—definitely worth trying once you're ready to be done! (I've pulled since I was 7—now 57—nothing else has worked as well)
Jennifer Walker Maine
Thanks to the course, I've seen major improvements in my overall tolerance to stressful life situations. I realized pulling frequency improved by 80–90%—from pulling all day every day for 25+ years to short stints every few days.
Melissa M.
Hear from real students who overcame trichotillomania.
