Understanding Hair Pulling Disorder: Causes and Treatments

Let’s Talk About Hair Pulling (Trichotillomania)

If you or someone you care about struggles with pulling out their own hair, you’re not alone—and you’re not broken. Hair pulling disorder, also called trichotillomania, is something many people deal with, often in silence. It’s more than just a “bad habit”—it’s a compulsive behavior that can be hard to stop, even when someone really wants to.

People often pull from their scalp, eyebrows, eyelashes, or other areas, and while they might try to resist the urge, the impulse can feel overwhelming. Over time, it can lead to visible hair loss, frustration, and deep feelings of shame or embarrassment.

But here’s the thing: understanding what’s going on is the first step toward taking back control. When left untreated, this disorder can affect confidence, relationships, and everyday life. But with the right support and tools, it’s absolutely possible to manage it and feel more like yourself again.

Why Do People Pull Their Hair?

There’s no one-size-fits-all answer here. Hair pulling usually develops from a mix of factors:

Family history: Some people are more prone to body-focused repetitive behaviors because of genetics.

Stress or emotional triggers: Anxiety, boredom, or even feeling overwhelmed can trigger pulling. For some, it’s a way to feel a moment of relief or release.

Habits and environments: You might find yourself pulling more often in certain settings—like while watching TV, working late, or feeling overstimulated.

Imagine someone up late trying to meet a deadline. The pressure builds, and without even thinking about it, they start tugging at their hair as a way to manage the tension. These little moments add up—and recognizing them is a key part of breaking the cycle.

How It Shows Up In Daily Life

Hair pulling doesn’t just affect someone’s appearance. It can impact confidence, relationships, and how safe they feel being seen. Some signs include:

• Strong, recurring urges to pull out hair

• Noticeable thinning or bald patches

• Rituals like examining or playing with pulled hair

  
  

Many people feel ashamed or guilty afterward, which—unfortunately—can fuel more pulling. It’s a tough cycle, and it’s totally understandable that someone might start avoiding social situations or hiding the behavior from loved ones.

So What Helps? Treatment That Makes a Difference

The good news: hair pulling is treatable. Here are a few approaches that can help:

Cognitive Behavioral Therapy (CBT), specifically Habit Reversal Therapy (HRT) and Comprehensive Behavior Therapy (ComB): This is a popular and effective treatment. It helps identify the thoughts and emotions that lead to pulling, and teaches healthier coping skills. Individual therapy also offers a space to explore personal triggers and build a plan that fits your needs.

Medication: In some cases, medication can reduce anxiety or help regulate mood—especially if pulling is connected to other mental health concerns.

Support groups: Talking to others who “get it” can make a huge difference. 

Getting Support in California and Michigan

If you’re in California or Michigan, you don’t need to leave home to get help. I offer virtual therapy sessions that make it easier to fit treatment into your life, wherever you are.

Working with a therapist who truly understands hair pulling can help you uncover the “why” behind the behavior and find a path forward that actually works.

Small Steps Matter

Deciding to get help for hair pulling is a brave and meaningful step. You don’t have to have everything figured out. Maybe you start by tracking when the urge hits. Maybe you reach out to a therapist or join an online group. These small shifts can set you on the path to real, lasting change.

You deserve support, and you don’t have to do this alone.

If you’re ready to take the next step, I’m here to help. I’m Azra A. Kim, LCSW, LMSW, and I offer compassionate, effective treatment for compulsive hair-pulling. Telehealth appointments are available in both California and Michigan, so you can get started from the comfort of home.