Merck Manual

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Hair-Pulling Disorder (Trichotillomania)


Katharine A. Phillips

, MD,

  • Weill Cornell Medical College
  • New York-Presbyterian Hospital

Dan J. Stein

, MD, PhD,

  • University of Cape Town

Last full review/revision Sep 2018| Content last modified Sep 2018
Click here for the Professional Version
Topic Resources

In hair-pulling disorder, people repeatedly pull their hair out, resulting in hair loss.

  • People with hair-pulling disorder may feel tense or anxious just before they pull their hair out, and the hair pulling may relieve that feeling.

  • Symptoms typically vary in intensity but may continue throughout life.

  • Doctors diagnose the disorder if people compulsively pull out enough hair to cause hair loss, try to stop pulling out their hair and cannot, and are significantly distressed by their behavior or function less well because of it.

  • Cognitive-behavioral therapy that specifically focuses on hair-pulling disorder and certain antidepressants or other drugs may help control symptoms.

Hair-pulling is a type of obsessive-compulsive disorder. People with this disorder compulsively pull or pluck out their hair for noncosmetic reasons. That is, they do not pull hair out to improve their appearance. They usually pull hair from their scalp, eyebrows, and/or eyelids, but any body hair may be pulled out.

Hair pulling typically begins just before or after puberty. About 1 to 2% of people have hair-pulling disorder. About 90% of adults with hair-pulling disorder are female.


How much hair is pulled out and where it is pulled from varies from person to person. Some people with hair-pulling disorder have areas of complete baldness. Eyelashes and/or eyebrows may be missing. Other people merely have thinned hair. People may change the spots they pull hair from over time.

Some people pull their hair out somewhat automatically, without thinking about it. Others are more conscious of the activity.

People with hair-pulling disorder do not pull out their hair because they are concerned about their appearance and trying to fix it (as people with body dysmorphic disorder are). However, they may feel tense or anxious just before they do it, and hair pulling may relieve that feeling. Afterward, they may feel gratified.

Many activities (rituals) may accompany hair pulling. People may painstakingly search for a particular kind of hair to pull. They may roll the hair between their fingers, pull the strands between their teeth, or bite the hair once it is pulled. Many swallow their hair. The swallowed hair may form a lump that becomes stuck in the stomach or other parts of the digestive tract. These lumps, called trichobezoars, may make people feel prematurely full or cause nausea, vomiting, pain, and other digestive symptoms.

Many people with hair-pulling disorder also repeatedly pick at their skin, bite their nails, chew their cheek, or do other repetitive body-focused activities. They may also have depression.

Affected people may feel embarrassed by or ashamed of the way they look or of their inability to control their behavior. They may try to camouflage the hair loss by wearing wigs or scarves. Some pull out hair from widely scattered areas to disguise the loss. People may avoid situations in which others may see the hair loss. They typically do not pull hair out in front of others, except for family members. People may also be distressed by their loss of control, and they usually repeatedly try to stop pulling their hair out.

Some people pull hair from other people or from pets or pull threads from clothing, blankets, or other textiles.

People with hair-pulling disorder typically try to stop pulling their hair out or to do it less often, but they cannot.

Symptoms typically vary in intensity but may continue throughout life.


  • A doctor's evaluation, based on specific diagnostic criteria

Doctors diagnose hair-pulling disorder based on symptoms:

  • Pulling out enough hair to cause hair loss

  • Repeatedly trying to decrease or stop pulling their hair out

  • Feeling significantly distressed or becoming less able to function because of the activity


  • Sometimes drugs

  • Cognitive-behavioral therapy

Sometimes doctors prescribe drugs to help control symptoms. Selective serotonin reuptake inhibitors or clomipramine (types of antidepressants) may help, particularly if the person also has symptoms of depression or anxiety. N-Acetylcysteine or olanzapine may also be helpful.

Cognitive-behavioral therapy that specifically focuses on hair-pulling disorder may also lessen symptoms. The form of cognitive-behavioral therapy that is most often used is habit reversal therapy. For this therapy, people are taught to do the following:

  • Become more aware of what they are doing

  • Identify situations that trigger the activity

  • Use strategies to help them stop themselves from pulling hair—for example, by substituting a different activity for hair pulling (such as clenching their fist, knitting, or sitting on their hands)

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