Obsessive-compulsive and related disorders
Trichotillomania
Trichotillomania, or hair-pulling disorder, is recurrent pulling that causes hair loss, together with repeated attempts to reduce or stop and clinically significant distress or interference.
Focused or automatic pulling
Pulling may affect the scalp, eyebrows, eyelashes, beard or other areas. Some people search for a hair with a particular texture and pull with full awareness; others pull almost automatically while reading, working or watching television.
Tension before and relief after pulling can occur but are not required. This is an obsessive-compulsive and related disorder—not a failure of self-control—and criticism rarely helps.
Assessment and impact
- Uneven hair loss, hairs of different lengths, attempts to conceal areas and avoidance of hairdressers, examination or intimacy may occur.
- A clinician rules out dermatological and medical causes and distinguishes pulling from appearance-driven behaviour in BDD or other repetitive movement patterns.
- Chewing or swallowing hair is important to disclose because it can rarely cause a dangerous mass in the digestive tract.
Treatment
CBT with habit-reversal training is a core treatment. It identifies early signals and teaches a competing response that is incompatible with pulling. Recording the setting, activity and emotional context can reveal focused and automatic patterns.
Stimulus-control strategies may include changing position or lighting, covering fingers or using safe objects for the hands. Family support focuses on skills rather than surveillance, threats or comments about appearance.
When to seek help
Seek assessment for visible hair loss, repeated failed attempts to stop, wounds or limitation of daily life. Persistent abdominal pain, repeated vomiting, swelling, difficulty eating, unexplained weight loss, serious bleeding or infection needs prompt medical assessment.