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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor can recognise trichotillomania, rule out other causes of hair loss and help with anxiety or low mood; habit reversal training is given by a psychologist or therapist.
- What it is: a strong urge to pull out your own hair, with tension before and relief after, that is hard to resist even when you want to stop.
- How common: up to 4 in 100 people. It usually starts between the ages of 10 and 13, and it is a recognised mental health condition, not a bad habit.
- What helps most: habit reversal training, a type of cognitive behavioural therapy (CBT). Antidepressants are not usually used for the pulling itself.
- Emergency: call 112 for severe tummy pain, repeated vomiting or a swollen tummy if you swallow hair, or if you might act on thoughts of suicide.
Do not book a video appointment if you swallow hair and have severe tummy pain, keep vomiting or your tummy is swollen, or if you might act on thoughts of suicide or have seriously hurt yourself. Call 112 or go to an emergency department.
Can an online doctor treat trichotillomania?
Partly. Trichotillomania is recognised from what you describe and how the hair loss looks, which a doctor can go through by video, privately and without judgement. The doctor checks that the patches are not alopecia areata or a scalp infection, helps with the anxiety, low mood or obsessive-compulsive symptoms that often come with it, explains the self-help that works, and arranges habit reversal training with a psychologist or therapist, which is the main treatment. Swallowed hair with tummy pain or vomiting needs an emergency department.
How an online consultation helps with trichotillomania
- Talked through without judgement: Many people hide hair pulling for years. Saying it out loud is often the first step.
- Other causes ruled out: Alopecia areata and scalp ringworm can look similar, and need different treatment.
- The therapy that works: Habit reversal training, what it involves, and how to find a psychologist or therapist.
- Anxiety and low mood treated: They often come with trichotillomania, and treating them can make the pulling easier to manage.
What the doctor checks in an online consultation for hair pulling
The doctor asks about your safety first, then about the pulling and how it affects you. The doctor asks about:
- Safety: whether you swallow hair and have tummy pain or vomiting, and thoughts of harming yourself or suicide, asked plainly because they matter.
- The pulling: where you pull from, how often, and whether you notice it or it happens without thinking.
- When it happens: stress, boredom, being alone, reading, screens or lying in bed.
- What you do with the hair: checking it, rolling it, biting, chewing or swallowing it.
- Other repetitive habits: skin picking, nail biting or cheek chewing.
- Your skin and scalp: sore, scabbed or infected areas.
- Your mood: anxiety, low mood, obsessive thoughts or rituals.
- What you have already tried: and what helped, even for a short time.
If you are comfortable, share photos of the areas in good light before the call. Some people find it easier to write a few notes about when the pulling happens and read from them.
What is trichotillomania?
Trichotillomania, also called trich or hair pulling disorder, is when someone cannot resist the urge to pull out their own hair, even when they want to stop. Most people feel tension building before they pull and relief afterwards. Over time the pulling leaves thin or bald patches.
It affects up to 4 in 100 people and usually starts between the ages of 10 and 13. In childhood it affects boys and girls equally; in adults, women are treated for it more often. Doctors group it with obsessive-compulsive and related conditions, as a body-focused repetitive behaviour, alongside skin picking.
Is trichotillomania a mental illness?
Yes. It is a recognised mental health condition, not a bad habit or a lack of willpower, and it rarely gets better just by being told to stop. With the right therapy, many people pull much less.
Is trichotillomania OCD or anxiety?
Neither exactly. It is related to obsessive-compulsive disorder (OCD), but OCD is driven by unwanted intrusive thoughts, while trichotillomania is mainly a repetitive behaviour. Stress and anxiety often trigger pulling, and depression, anxiety and OCD are more common in people with trichotillomania.
What are the symptoms of trichotillomania?
- A strong urge to pull out hair, with tension before pulling and relief or pleasure afterwards.
- Pulling from the scalp, most often, or the eyebrows, eyelashes, beard or pubic hair.
- Patches of hair loss with an unusual shape, different on each side, with broken hairs of different lengths that feel stubbly.
- Rituals, such as looking for just the right hair, or rolling, biting or chewing pulled hair.
- Trying to stop again and again without success.
- Hiding the patches with hairstyles, hats, make-up or false eyelashes, and feeling ashamed or embarrassed.
Focused and automatic pulling
Some pulling is focused: done on purpose to ease tension or distress. Some is automatic: it happens without noticing, for example while watching television, reading or falling asleep. Most people do both, and knowing which kind you do helps choose the right strategies.
What triggers trichotillomania?
The cause is not fully understood. It probably comes from a mix of genes and learned patterns, and several things make it more likely:
- using pulling to cope with stress, anxiety or difficult feelings
- boredom, being alone, and quiet times such as reading or lying in bed
- hormone changes around puberty
- a close relative with trichotillomania
- an itchy or uncomfortable scalp, which draws attention to the hair
Why does pulling hair feel good?
Pulling brings quick relief from tension, and sometimes a feeling of pleasure or satisfaction. That relief rewards the behaviour, so the urge comes back stronger next time, which is why it becomes a habit that is hard to break.
Is it trichotillomania or another cause of hair loss?
Patchy hair loss has several causes. The doctor looks at the pattern and the hairs, and may arrange an examination when it is unclear:
Swipe sideways to compare →
| Condition | What the patches look like | Where to read more |
|---|---|---|
| Trichotillomania | Irregular patches with broken hairs of different lengths, often on the side you use to pull | This page |
| Alopecia areata | Smooth, round patches with short hairs narrower at the root | Alopecia areata |
| Scalp ringworm | Scaly, itchy patches with broken hairs, sometimes swollen glands | Scalp ringworm |
| Tight hairstyles | Thinning where hair is pulled tight, often along the hairline | Traction alopecia |
How do you stop trichotillomania?
With habit reversal training: noticing exactly when and why you pull, doing something else with your hands instead, making pulling harder, and getting support from people you trust. It is a type of cognitive behavioural therapy (CBT), and it is the treatment that works best.
Habit reversal training, step by step
- Awareness: keep a diary of when, where and how you pull, and how you feel before and after.
- Triggers: spot the situations, places and feelings that lead to pulling, and avoid or change them where you can.
- A competing response: when the urge comes, do something with your hands that makes pulling impossible, such as clenching your fist or squeezing a stress ball, until the urge passes.
- Support: tell people you trust, so they can gently remind you and encourage you.
Self-help that people with trichotillomania recommend
- squeezing a stress ball or using a fidget toy
- clenching your fist and tensing your arm muscles
- putting plasters on your fingertips, or wearing gloves at times you often pull
- wearing a bandana or a tight hat
- keeping your hair cut short
- taking a soothing bath, deep breathing or exercise
Talking openly with people you trust helps many people pull less, because hiding it can make anxiety worse. Slips are normal, and a slip does not mean the treatment has failed.
Which trichotillomania treatment might the doctor recommend?
Treatment depends on how much the pulling affects you, what triggers it and what else is going on. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Pulling that you want to reduce | Self-help and habit reversal training | Partly | For the therapy, with a psychologist or therapist |
| Pulling with anxiety or low mood | Treatment for anxiety or depression, alongside therapy | Yes | Not usually needed |
| Pulling with obsessive thoughts or rituals | Assessment for OCD, and the therapy that fits | Partly | For specialist therapy |
| Sore, scabbed or infected areas | Treatment of the skin, and protecting it while it heals | Yes | If the infection spreads |
| Swallowing hair, with tummy pain, sickness or weight loss | Urgent assessment for a hairball | No | Now, at an emergency department |
Want to stop pulling? A doctor can help you start in one consultation.
See available times →Treatment options for trichotillomania
Habit reversal training and CBT
Habit reversal training is the main treatment, given by a psychologist or therapist over several sessions. Other talking therapies, such as acceptance and commitment therapy (ACT) and dialectical behaviour therapy (DBT), are sometimes added.
Medicines
Antidepressants are not usually prescribed for the pulling itself, but they can help when depression or anxiety comes with it, and a specialist may try them when therapy has not been enough. N-acetylcysteine, a supplement, may reduce urges: in one small trial of 50 adults, 56 in 100 taking it improved a lot over 12 weeks, compared with 16 in 100 taking a dummy treatment, and the evidence is still limited. Talk to the doctor before starting it. A prescription is never issued without a consultation, and if the doctor prescribes, use the prescription at a pharmacy near you.
Will my hair grow back?
Usually, yes, once the pulling stops, because new hairs grow from the same follicles. Years of repeated pulling can damage follicles and leave scarring, and hair may not regrow there. Eyebrows and eyelashes can take many months.
If it comes back
Slips and relapses are common, especially at stressful times. Going back to the strategies that worked, or to your therapist, usually helps.
Is trichotillomania self-harm?
Not usually. Most people pull to relieve tension, or without noticing, rather than to cause pain, and doctors group trichotillomania with obsessive-compulsive and related conditions. But it can damage the skin and hair, and it often comes with anxiety, low mood and shame. The doctor asks about these plainly, without judgement.
If you hurt yourself on purpose in other ways, the self-harm page explains the help available. If you have thoughts of suicide, see suicidal thoughts. If you might act on them, call 112.
What happens if you swallow your hair?
About 1 to 2 in 10 people with trichotillomania chew or swallow pulled hair. Hair cannot be digested, and over months or years it can build up into a hairball in the stomach or bowel, called a trichobezoar. This is rare, but it can block the bowel, and it may need an operation.
Tell the doctor if you swallow hair, even if you feel well. Tummy pain, feeling or being sick, feeling full quickly, or losing weight without trying need a doctor promptly, and severe pain, repeated vomiting or a swollen tummy mean 112.
Special situations
Skin picking, nail biting and cheek chewing
These are related body-focused repetitive behaviours, and many people have more than one. Habit reversal training works for them in the same way.
Pulling eyelashes and eyebrows
Gaps in the eyelashes or eyebrows can be hidden with make-up, eyebrow pencils or glasses while they regrow. Wearing glasses can also make pulling eyelashes harder.
Children
In young children, hair pulling is often short-lived and many grow out of it. Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When trichotillomania is treated online, and when you need in-person care
Treated online: recognising trichotillomania, ruling out other causes of hair loss on photos, self-help and habit reversal strategies, treating anxiety and depression, sore or infected skin, and arranging therapy.
In-person care: habit reversal training and other therapy with a psychologist or therapist, specialist care for severe pulling or OCD, an examination when the cause of the patches is unclear, and emergency care for a swallowed hairball.
When to get in-person care
Call 112 or go to an emergency department now for:
- severe tummy pain, repeated vomiting or a swollen tummy if you swallow hair
- thoughts of suicide that you might act on
- a serious injury from harming yourself
Get medical advice the same day for:
- tummy pain, feeling sick or feeling full quickly if you swallow hair
- a pulled area that is hot, swollen and spreading, or leaking pus, especially with a high temperature
- thoughts of harming yourself, even if you do not plan to act on them
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor in private: say where and when you pull, what you have tried, and how it affects you. Share photos only if you are comfortable.
- Leave with a plan: the self-help to start with, how to arrange habit reversal training, what to take if anything, and which signs mean you should be seen in person.
No sign-up needed
Not sure it’s trichotillomania? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Alopecia Areata can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about trichotillomania
What is trichotillomania?
Trichotillomania is a mental health condition in which you cannot resist the urge to pull out your own hair, even when you want to stop. It usually starts between the ages of 10 and 13, and it affects up to 4 in 100 people.
What triggers trichotillomania?
Common triggers of trichotillomania are stress, anxiety, boredom, being alone, and quiet times such as reading or lying in bed. It can run in families, and hormone changes around puberty may play a part.
Is trichotillomania OCD or anxiety?
It is related to OCD but not the same: OCD is driven by intrusive thoughts, while trichotillomania is mainly a repetitive behaviour. Anxiety often triggers pulling, and anxiety, depression and OCD are more common in people with it.
How do you stop trichotillomania?
Habit reversal training works best for trichotillomania: noticing when you pull, doing something else with your hands when the urge comes, making pulling harder, and getting support. A psychologist or therapist can guide you through it.
What can I do myself to stop hair pulling?
Start a pulling diary: note when, where and how you feel each time, because trichotillomania usually has patterns, such as reading, screens, bed or stress. Then make pulling harder in those moments, with a hat, gloves, hair tied back, short nails or fidget toys, and use a competing response, clenching your fists for a minute when the urge comes. Tell someone you trust, and be kind to yourself after a slip; a therapist can turn these steps into a full habit reversal programme.
Is trichotillomania a mental illness?
Yes. Trichotillomania is a recognised mental health condition, grouped with obsessive-compulsive and related conditions. It is not a bad habit or a lack of willpower.
Is trichotillomania self-harm?
Not usually. Most people with trichotillomania pull to relieve tension or without noticing, rather than to cause pain. It can come with low mood and thoughts of self-harm, so tell a doctor if you have them.
Why does pulling hair feel good?
Pulling brings quick relief from tension, and sometimes pleasure. That relief rewards the behaviour, so the urge comes back stronger, which is why it is hard to stop.
Will my hair grow back after trichotillomania?
Usually, yes, once the pulling stops: in trichotillomania the follicles are irritated rather than destroyed, so hair grows back over months, often finer or a different texture at first. Years of repeated pulling from the same spot can scar the follicles, and hair may not regrow in those areas, which is one reason getting help early matters.
Does trichotillomania go away?
For some people, especially when it starts in early childhood, trichotillomania fades on its own within a year or two; when it starts around puberty or later it tends to last, waxing and waning with stress, unless it is treated. With habit reversal training most people pull far less, and many stop, though urges can return at hard times, which is why the skills are kept up. The hair usually grows back once the pulling stops.
Can trichotillomania be prevented?
There is no known way to prevent trichotillomania starting, because genes, temperament and hormone changes around puberty all play a part, but relapses can be: keep using the habit reversal skills after the pulling has stopped, especially at the times that used to trigger it, treat anxiety, low mood or boredom before they build, keep sleep regular, and plan for high-risk situations such as exams, long screen time or being alone in the evening.
Can medicine help trichotillomania?
Antidepressants are not usually used for the pulling itself, but they help when depression or anxiety comes with it. N-acetylcysteine, a supplement, helped in one small trial, and the evidence is still limited.
What happens if you eat your hair?
Swallowed hair, which some people with trichotillomania eat, cannot be digested and can build up into a hairball that blocks the stomach or bowel. Tummy pain, vomiting or weight loss need a doctor, and severe pain or a swollen tummy is an emergency.
How common is trichotillomania?
Trichotillomania affects up to 4 in 100 people, and many hide it for years out of shame, so it is more common than most people think. It usually starts between the ages of 10 and 13; in childhood it affects boys and girls equally, while among adults who seek help most are women. Pulling eyelashes, eyebrows or body hair counts as well as pulling from the scalp.
Can an online doctor help with trichotillomania?
Partly. A doctor can recognise trichotillomania, rule out other causes of hair loss, treat anxiety or low mood and arrange habit reversal training. The therapy itself is given by a psychologist or therapist.
- Trichotillomania (hair pulling disorder), NHS, National Health Service (UK), reviewed 5 February 2024.
- Trichotillomania (hair-pulling disorder): symptoms and causes, Mayo Clinic (US), 22 November 2023.
- Trichotillomania (hair pulling disorder), Cleveland Clinic (US), updated 10 June 2026.
- Trichotillomania, DermNet, New Zealand, updated June 2024.
- Trichotillomania (hair pulling disorder), OCD-UK, accessed 15 October 2026.
- N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study, Grant JE, Odlaug BL, Kim SW. Archives of General Psychiatry, 2009.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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