Trichotillomania/ Compulsive Hair Pulling

Pulling or plucking hair is often a part of normal grooming behavior. However for some people this normal behavior seems to take on a life of its own, becoming an uncontrollable impulse, and can cause many problems for the person including bald spots or thinning of the hair as well as feelings of guilt and shame. CBT can help you understand why this happens and how to stop pulling hair successfully.

Trichotillomania (Trich) is characterized by repeatedly pulling hair from any site on the body (scalp, eye lashes/brows, pubic, arms, legs, etc.) to the extent that noticeable bald spots or thinning of the hair develops. Some people describe a feeling of building tension in their body that is relieved by the pulling, however this is not the case for all people who pull. For some people, pulling is more about the sensory experience than it is about their emotional state before the pulling. Trich often starts during childhood usually around the age of 7-11 years old, though some parents report their child was focused on hair (touching, playing, pulling) long before the pulling began.

Types of Pulling

There are two different types of pulling: focused and automatic.

Focused pulling is used to describe pulling that the person is actively aware of. In these situations the person feels a strong urge to pull that they then consciously act on. These urges can be triggered by a variety of things including environment, emotions, or specific behaviors.

Automatic pulling identifies pulling that takes place outside the person’s immediate awareness. In these situations people often do not realize they are pulling until something/someone brings their attention to it.

Although some people experience only one or the other, a large number of people engage in both types of pulling.

Rituals and Routines

Pulling for many people often involves rituals or routines related to how they pick hairs to be pulled, how they pull the hair, and what they do with the hair once it has been pulled. Some people look for certain types of hair to pull. The selection may be related to the color, texture, or length of the hair. Other times it may be based on the hair looking “out of place” or “wrong”. Once a hair has been selected, some people also have specific ways they pull the hair including using certain fingers or a particular motion. Others may even use things to aid them in their pulling such as mirrors or tweezers. In addition to the routines and rituals related to pulling, there are many different things that people do with the hair once they have pulled it, ranging from discarding the hair in various ways, playing with it, and/or chewing or swallowing the hair or hair root. Although most of these rituals do not have any serious health side effects, swallowing the hair can lead to a build-up of hair that can eventually cause blockage in the intestinal system.


The Trichotillomania Learning Center has identified CBT as the treatment of choice for people struggling with Trich. When using CBT, you and your therapist begin by identify the triggers for your pulling as well as what things perpetuate the pulling in order to help you develop specific tools and strategies to more effectively intervene and stop pulling behaviors.