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Trichotillomania or Hair Pulling

trichTrichotillomania, hair pulling is the recurrent pulling out of your own hair that can occur from any area of the body where hair grows. The places that you pull from may also change over time but in general the most common places include the scalp, eyebrows and eyelashes. That does not mean that puling is limited to these areas. Less common areas include face, pubic area, and near the rectum.

The episodes of pulling happen throughout the day in short periods, or less frequently seen long periods that may last for hours. The pulling may come episodically or can have been sustained for years. The pulling causes hair loss even if it is not always obvious or can be concealed using wigs, scarves, hats, makeup etc.

Often the person pulling can have a sense of a loss of control, shame or a wide range of negative emotions directed toward themselves. The person has made significant efforts to stop without consistent success. The problem eventually causes some form of impairment from mild to severe in social, occupational, academic and leisure activities. The distress often ends in avoidance, at some level, of work, school and social events.


Ritualistic behaviors may be seen including searching for a particular kind of hair, thick, thin, rough, smooth, etc. An individual may pull in a certain way, they may or may not want the hair to have a root. The may choose to strip, split or play with the hair. A person may pull the hair through their teeth, bite the hair into pieces or swallow the hair.

Often individuals that the pulls are triggered by anxiety, stress or boredom. Anxiety may go up prior to pulling or when resisting a pull. Anxiety may also follow a pull. Often individuals report a sense of relief or gratification after the pull. Conscious awareness of pulling falls on a continuum from automatic pulling out of awareness (at least at the beginning stage of the episode) to full awareness. Most people report that they experience both.

For some people the onset of a pull can be triggered by tingling or an itch like sensation. Pulling is not generally reported as painful. Often people who have trichotillomania also have one or more other body-focused repetitive behaviors, including skin picking, nail biting, and lip chewing.

We work with individuals in the Greater Philadelphia Area including Montgomery County and the Main Line.

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