Treatment Methods for Hair-Pulling Anxiety


Trichotillomania or hair-pulling anxiety disorder is the recurrent pulling out of your own hair that can occur on any area of the body where hair grows. The places that you pull from may also change over time. In general, the common places to pull hair include,

  • More Common Areas: Scalp, eyebrows, eyelashes.
  • Less Common Areas: Face, pubic area, and near the rectum.

When and how long are the events?

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

Trichotillomania can cause social, occupational, or academic impairment.

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 mild to severe impairment in social, occupational, academic, and/or leisure activities. The distress often ends in avoidance, at some level, of work, school, and social events.

Ritualistic behaviors may be present.

Ritualistic behaviors commonly occur. A sufferer can search for a particular kind of hair, such as thick, thin, rough, or smooth hair. An individual may pull in a certain way. For instance, they may or may not want the hair to have a root. They may choose to strip, split, or play with the hair. Furthermore, a person may pull the hair through their teeth, bite the hair into pieces, or swallow the hair.

Anxiety, stress, or boredom can be a trigger.

Anxiety, stress, or boredom may trigger episodes of hair-pulling. Furthermore, Anxiety may increase prior to pulling or when resisting the urge to pull. Anxiety may also follow a pull, but individuals commonly report a sense of relief or gratification after a 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.

Tingling or itch-like sensations can trigger pulling episodes.

For some people, the onset of a pull can be triggered by tingling or an itch like sensation. However, people do not generally report pulling as painful. Oftentimes, people who have trichotillomania also experience one or more other body-focused repetitive behaviors (bfrb’s), such as skin picking, nail-biting, and lip chewing.

If you or someone you care about is suffering from trichotillomania, please contact us at 610-517-3127. We work with individuals in the Greater Philadelphia Area including Montgomery County and the Main Line.