Trichotillomania
Hair Pulling Disorder in Children, Teens, and Adults
Natalie Noel, LMHC | Anxiety & OCD Treatment Specialists | Tampa, FL
Read More About Our Specialties
You notice clumps of hair on the pillow. Bald spots you have been covering with hats or headbands. You reach up repeatedly sometimes without even realizing you are doing it and pull. The urge feels impossible to ignore. The relief lasts only seconds. And then the shame comes.
If this sounds familiar, you are not alone. Trichotillomania affects about 1 to 2 percent of the population. It is one of the most common body-focused repetitive behaviors and treatable, with the right specialist.
At Anxiety & OCD Treatment Specialists, we help children, teens, and adults with trichotillomania in Tampa, Florida, and virtually across Florida.
In-person sessions are provided in Tampa and virtual sessions are available throughout Florida and New York.
Quick Answer: What Is Trichotillomania?
Trichotillomania (often called ‘trich’) is a body-focused repetitive behavior involving a compulsive urge to pull out hair from the scalp, eyebrows, eyelashes, beard, or other areas of the body. It is not a habit or a choice. It is a recognized mental health condition in the DSM-5, classified under Obsessive-Compulsive and Related Disorders. It is treatable with specialized behavioral therapy.
What Is Trichotillomania?
Trichotillomania is more than just playing with your hair. People with trich experience a real, physical urge to pull. Most describe a building tension before pulling and a brief sense of relief or satisfaction immediately afterward, almost like releasing pressure from a valve.
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That relief is what makes it so hard to stop. The brain learns that pulling reduces discomfort. Over time, the urge gets stronger. The pulling happens more often and often more automatically, without full awareness.
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Trichotillomania is not attention-seeking, not a bad habit, and not something a person can simply choose to stop. It is a neurological condition that responds to specialized behavioral treatment.
Signs of Trichotillomania
- Pulling hair from the scalp, eyebrows, eyelashes, beard, pubic area, or body
- Noticeable thinning, bald patches, or missing eyebrows or eyelashes
- Pulling that happens automatically while reading, watching TV, driving, or falling asleep
- Examining, twirling, or mouthing pulled hairs after removal
- Feeling a strong urge or tension before pulling, followed by relief
- Hiding hair loss with hats, scarves, makeup, or false lashes
- Avoiding activities like swimming, wind, or intimacy because of appearance
- Repeated failed attempts to stop or cut back
- Distress, shame, or embarrassment about the behavior
Trichotillomania in Children, Teens, and Adults
Trichotillomania looks different depending on age. Understanding these differences helps with early identification and the right treatment approach.
| Age Group | How It Often Looks | Common Pulling Sites |
|---|---|---|
| Young Children (2–5) | Often episodic and less distress-driven. May look more like exploratory behavior. Often resolves without treatment. | Scalp hair often while falling asleep or watching TV |
| Older Children (6–12) | Becomes more habitual. Shame and hiding begin. May start affecting school or friendships. | Scalp, eyebrows, eyelashes |
| Teenagers (13–17) | Often most intense. Body image and peer perception amplify shame. May coincide with anxiety or depression. | Scalp, eyebrows, eyelashes, body hair |
| Adults (18+) | Often long-standing and deeply habitual. May have been hidden for years. Triggers are more complex. | Scalp, eyebrows, eyelashes, pubic hair, body hair |
Trichotillomania in Young Children
Hair pulling in very young children under age 5 is often different from clinical trichotillomania. It can be a self-soothing behavior that fades on its own. If it persists past age 5, increases in intensity, or causes distress, a specialist evaluation is recommended.
Trichotillomania in Older Children and Teens
This is when trich most often becomes a true clinical condition. Shame develops quickly, and children start hiding the behavior. They may wear hats constantly, avoid PE class, or refuse to go to sleepovers. The longer it goes unaddressed, the more entrenched it becomes.
Parents play a crucial role in early treatment. The most helpful response is calm, non-judgmental curiosity not alarm, punishment, or repeated reminders to stop.
Telling a child or teen to ‘just stop pulling’ is like telling someone with a broken leg to just walk normally. It doesn’t work and it adds shame on top of an already painful experience. The right treatment gives them actual tools to change the behavior.
What Causes Trichotillomania?
No single cause explains trichotillomania. It is usually a combination of:
- Genetics. Trich tends to run in families. OCD and other anxiety conditions in the family increase the risk.
- Brain differences. Research shows differences in how the brain processes urges and reward in people with trich similar to OCD.
- Stress and emotional regulation. Pulling often increases during stressful periods. The behavior becomes a way of managing uncomfortable emotions.
- Sensory needs. Many people describe a sensory component seeking a specific texture, resistance, or 'just right' feeling from pulling.
- Automatic behavior. Many episodes happen without awareness during focused activities or while drifting off to sleep.
How Is Trichotillomania Treated?
The most important thing to know: trichotillomania is very treatable. General talk therapy is rarely enough. You need a specialist trained in BFRB-specific methods.
Habit Reversal Training (HRT)
The Comprehensive Behavioral Treatment Model (ComB)
ComB is currently considered the gold standard for trichotillomania treatment. Rather than a one-size-fits-all approach, ComB assesses your specific triggers across sensory, emotional, cognitive, motor, and environmental categories then builds a treatment plan targeting your individual pattern. It is especially useful when HRT alone has not produced lasting results.
About Medication
There is no FDA-approved medication specifically for trichotillomania. However, some medications including SSRIs and N-acetylcysteine (NAC) have shown benefit in research and may help some people, particularly when anxiety or OCD is also present.
We are therapists and do not prescribe medication. If medication may be appropriate, we will refer you to a trusted psychiatrist and coordinate your care. Behavioral therapy HRT and ComB remains the most effective treatment for trich.
What to Expect When You Work With Us
- Free consultation. A 10-minute call to hear what is going on with zero judgment.
- Full assessment. We assess your specific pulling patterns, triggers, history, and any co-occurring conditions.
- A personalized plan. HRT, ComB, or a combination built around how your trich actually works.
- Parent involvement for children and teens. Parents are actively included in sessions and given specific guidance for home support.
- Real-life practice tools. Recovery happens in daily life. We give you skills to use in real moments not just in sessions.
For Parents: How to Talk to Your Child About Trichotillomania
Do not react with shock, anger, or punishment this increases shame and drives the behavior underground.
Do not repeatedly remind them to stop pulling it rarely helps and often makes things worse.
Do say: ‘I noticed something and I want you to know I am not upset. I want to help you.’
Do validate how hard it is: ‘I know this feels really hard to control. That is why we are getting help.’
Contact a specialist who works with children and BFRBs early treatment leads to better outcomes.
Ask the therapist what your role at home should look like. You will be an important part of the plan.
In-Person and Virtual Sessions
In-person
730 S Sterling Ave, Suite 306, Tampa, FL 33609
Virtual
Available throughout Florida
Virtual sessions are highly effective for trichotillomania. Being in your home where pulling most often happens helps you and your therapist identify real-time triggers and practice skills in context.
Frequently Asked Questions
Is trichotillomania a form of OCD?
They are in the same family of conditions Obsessive-Compulsive and Related Disorders in the DSM-5 but they are not the same. OCD is driven by obsessions and the need to neutralize anxiety with compulsions. Trich is driven more by urges, tension relief, and sensory needs. Some people have both. A proper assessment will clarify what is going on and guide treatment.
My child keeps pulling their eyelashes. Is this trichotillomania?
It may be. Pulling eyelashes, eyebrows, or scalp hair that happens repeatedly and is difficult to stop especially if your child seems distressed about it or is hiding it warrants an evaluation. Early treatment for trichotillomania in children tends to lead to better long-term outcomes. The sooner you get support, the easier it is to address.
Why can I not just stop on my own?
Because willpower alone is not enough for most people with trich. The pulling behavior is neurologically driven it is deeply embedded in the brain’s reward system. It takes specific behavioral techniques, practiced consistently over time, to retrain that response. That is what HRT and ComB are designed to do. Many people try for years on their own before getting specialized help.
Will my hair grow back?
In most cases, yes especially when pulling stops before prolonged damage to the follicles. Some people who have pulled from the same sites for many years may have some permanent follicle damage, but this is less common. A dermatologist can assess the specific areas if you are concerned. The most important step is reducing pulling which treatment helps you do.
Is trichotillomania more common in girls than boys?
In adults, trich is more often diagnosed in women than men but this likely reflects reporting differences as much as true prevalence. In young children, it affects boys and girls at similar rates. In teens and adults, women are more likely to seek help, but trich is not rare in men or non-binary individuals. All genders deserve and respond to treatment.
Can trich come back after treatment?
It can especially during stressful periods. This is normal and does not mean treatment failed. Part of a good treatment plan is building relapse prevention skills so you know exactly what to do if urges increase. Many people find that when trich returns after treatment, they are able to address it much more quickly because they already have the tools.
You Have Tried to Stop Long Enough on Your Own.
Trichotillomania does not go away by wanting it to. But with the right specialist, the right approach, and consistent practice, real and lasting change is possible for children, teens, and adults.