Written by Philip Kingsley Trichologist, Jane Martins.

What is trichotillomania?

Trichotillomania is a hair-pulling disorder that results in noticeable hair loss from repeated pulling, twisting or plucking of the hair, most often from the scalp, eyebrows or eyelashes. It is classified as a body-focused repetitive behaviour and sits alongside conditions such as skin-picking disorder. It is not a sign of vanity or a habit someone can simply choose to stop; for many people it is a way of managing stress, anxiety or difficult emotions, often without full awareness of the behaviour in the moment. It is most commonly diagnosed in children around puberty and in adult women, and can be lifelong or come and go over a period of years.

Why it happens

The exact cause is not fully understood, and it can look different from person to person. Some people pull hair in response to stress, anxiety or a specific sensation on the scalp; others describe it as a way of self-soothing, similar to nail-biting, that can happen almost automatically while watching television, reading or on the phone. It is important to understand that hair pulling is a recognised mental health condition, not a matter of willpower, and treating it usually means addressing the underlying urge rather than just the hair loss it causes.

How it differs from alopecia areata

Trichotillomania is often mistaken for alopecia areata, an autoimmune condition that also causes patchy hair loss, because both can present as irregular bald patches. A Trichologist can usually tell the difference by examining the pattern of loss and the condition of the remaining hairs: pulled hair tends to leave broken strands of uneven length, while alopecia areata leaves a smoother, completely bald patch. Getting the right diagnosis matters, since the two conditions need very different approaches to treatment. Left unaddressed, prolonged pulling can eventually damage the hair follicle enough that regrowth becomes difficult, which is one reason early, non-judgemental support is worth seeking out.

Steps that can help

There is no single treatment that resolves trichotillomania for everyone, and the most effective approach usually involves professional psychological support, such as habit reversal training or cognitive behavioural therapy, alongside practical steps at home. These can include:

• Acceptance – a willingness to acknowledge the problem and identify the possible causes.

• Substituting the hair pulling behaviour with a positive alternative.

• Wearing gloves or a hat during high-risk moments, such as in the evening, to interrupt the physical habit.

• Keeping a record of when pulling happens, to identify triggers such as boredom, stress or specific settings.

Breaking the habit takes time and, for many people, professional support alongside self-help strategies. Where pulling has been long-standing, hair usually grows back once it stops, though it can occasionally regrow with a different texture. Applying a leave-in conditioner or oil to the affected area can make hair harder to grip, which some people find reduces the urge to pull.

When to seek support

If hair pulling is affecting your confidence, causing visible hair loss, or feels difficult to control, it is worth speaking to a GP or a mental health professional as a first step, alongside a Trichologist for scalp and hair health support. Trichotillomania is a recognised condition, and reaching out for help is a sign of strength, not a failure of willpower.