Trichotillomania (Hair Pulling Disorder)

1) What it is

Trichotillomania is a condition involving repeated urges to pull out hair from the scalp, eyebrows, eyelashes, or other areas. Pulling often brings temporary relief but is followed by shame or distress.

2) What it feels like

• “I feel tension before pulling.”
• “I feel calmer afterwards.”

3) Common signs & symptoms

• repeated urges to pull hair
• tension before pulling
• relief after
• patchy hair loss
• secrecy or shame

4) Why it happens

• anxiety and stress relief
• emotional regulation difficulties
• habit loop (tension → pull → relief)
• sensory seeking or boredom

5) Triggers

• fatigue
• boredom
• stress
• certain environments

6) What helps now

• urge delay (2, 5, then 10 minutes)
• substitute actions (fidget tools, textured objects)
• barrier methods (gloves, hats, gel nails)
• pattern tracking

7) Daily self-help support

• reduce shame
• build awareness gently
• increase competing behaviours

8) Professional treatment options

• Habit Reversal Training (HRT)
• CBT
• Acceptance and Commitment Therapy (ACT)

9) Medication

Medication may help if OCD or anxiety features are present.

10) Practical tips

• urges rise and fall
• this is a coping system, not a flaw

11) When to seek urgent help

Urgent help if pulling causes injury or severe distress.

12) Where to get help (UK)

• NHS Talking Therapies
• GP referral if severe

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