Trichotillomania Manhattan
Therapy for Lasting Relief
Struggling with certain habits or urges is something many people experience from time to time. But when those urges become persistent, disruptive, and hard to control, they can start to affect your daily life in ways that feel isolating and confusing.
One such experience involves repetitive behaviors centered around pulling out strands of hair. For some, this isn’t just a habit, it’s something deeper and more complex.
If you’ve found yourself caught in a cycle of pulling hair without fully understanding why, or feeling distressed by it, you’re not alone. This experience may be a sign of something more serious.
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What is Trichotillomania?
For those who have Trichotillomania, the urge to pull out your hair is recurrent and impossible to resist. Those who suffer from this disorder will often try to stop the damaging behavior but ultimately can’t control the impulse. This can cause noticeable hair loss and lead to the development of bald patches, which then causes extreme distress and self-consciousness.
This distress can hinder one’s daily functioning, bringing a great deal of anxiety to social plans or work. People with hair pulling disorder may try very hard to conceal their hair loss or bald patches, wearing wigs or hats to keep their condition undetectable.
Trichotillomania looks different depending on the person, and it can range from manageable to debilitating. Some people with this disorder can manage it for the most part and live a normal life, while others may feel that their lives are completely overtaken by it. Trich is considered to be a life-long disorder.
Who is Affected by Trichotillomania?
Although Trich can affect people in any age range, it most frequently starts in early adolescence, typically between 10 and 13 years old, according to the Mayo Clinic. Before puberty, it affects equal numbers of females and males. Studies show that 1 in 50 people will suffer from hair pulling disorder throughout their lifetime.
However, after puberty, there are higher rates in women than in men, with women being four times more likely to be diagnosed than men. However, women are more likely to seek help for mental disorders than men, so scientists are unsure what the true difference is.
Recognizing the Symptoms
The primary symptom of Trichotillomania is pulling one’s hair out, but this is often accompanied by feelings or other related behaviors. Some common signs of Trich include:
Pulling your hair out repeatedly, from your scalp, eyelashes, eyebrows, or other body areas
A feeling of tension or stress that builds if you resist the urge to pull and is alleviated after hair is pulled
Hair loss, like bald patches on the scalp or missing eyelashes
Patterns of hair pulling, or rituals that accompany the action
Chewing or eating hair that’s been pulled out
Touching or playing with pulled-out hair
Attempting without success to stop pulling your hair out
Issues with daily functioning, such as work, school or social life, due to pulling your hair out
Low self-esteem or shame because of hair pulling
Trichotillomania often goes hand in hand with other habits like biting your nails, picking your skin or chewing your lips. Some cope with their urge to pull their hair out by pulling hair or thread from objects like blankets, pets or dolls.
It's common for people with Trichotillomania to attempt to keep the disorder hidden, pulling hair out in private and attempting to conceal the urge in public.
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How It Shows Up Differently
Trichotillomania can manifest in a number of different ways, and it looks different depending on the person.
Some people with Trich pull their hair out intentionally to alleviate the tension they feel.
Others engage in the behavior distractedly while in the middle of an activity, without even realizing they’re doing it.
Some may do a combination, pulling their hair out intentionally at times and automatically at other times.
Some with Trich develop elaborate rituals, like selecting the perfect hair to pull out or rubbing pulled-out hair on their face. Trich can also be related to emotions. For instance, some use the activity to cope with negative feelings like stress, boredom, fatigue or frustration.
Others pull out their hair because it feels satisfying and comes with a sensation of relief. For some, Trich can become an addiction, and the more someone pulls their hair out, the more they want to do it.
This chronic disorder can change over time, getting worse during various moments of one’s life. Since some engage in hair-pulling due to stress, the disorder can worsen during difficult times such as a divorce or lay-off. Symptoms can be present or dormant for weeks, months or even years at a time. A small subset of people will have Trich for just a few years of their life.
Understanding the Causes and Risks
Researchers haven’t discovered the exact cause of Trichotillomania, but there are a number of theories. Some potential causes include:
Stress or difficult life events
Chemical imbalance in the brain
Change in hormones during puberty
Risk Factors
While the root causes remain unclear, certain risk factors are associated with higher chances of developing Trichotillomania:
Genetics: those who have a close relative with the disorder are more likely to develop it themself
Age: the most common age to develop Trichotillomania is between 10 and 13 years old
Other mental health disorders: there are a few mental health disorders that make it more likely that you’ll develop Trichotillomania. Those with OCD, major depressive disorder, anxiety disorders and substance use disorders have a higher chance of developing Trich
Stress: extreme stress or difficult life events can trigger hair pulling disorder
How Trichotillomania Impacts Your Life
Trichotillomania can be a minor, manageable condition for some, while it greatly affects the daily functioning of others. Some ways that hair pulling disorder can impact your life include:
Distress
It’s common for those with Trichotillomania to feel shame and embarrassment about their hair-pulling habit. This can lead to low self-esteem, depression, drug use and anxiety.
Difficulty Functioning in Daily Life
Trichotillomania can greatly affect one’s ability to function in day-to-day life. The embarrassment and shame can cause people to avoid social situations or in-person jobs, leading to isolation and a lack of intimacy. Many will go to great lengths to keep their condition from being discovered.
Damage to Skin and Hair
Chronic hair pulling can cause lasting damage to both the skin and hair. Over time, repeated pulling may lead to irritation, open wounds, scarring, and permanent hair loss. In some cases, infections can develop, especially if the skin is broken or repeatedly inflamed due to ongoing hair-pulling behavior.
Hairballs
Those with Trichotillomania who eat their hair can damage their digestive tract. Habitually eating your hair can cause a large hairball to form. In serious cases, this can cause health issues like weight loss, obstruction of your intestines and death.
Effective Trichotillomania Treatment Options That Work
Trichotillomania is a chronic disorder in most cases, but with the right treatment it can be a manageable disorder that doesn’t greatly affect one’s daily life.
Medications are typically not used to treat this chronic disorder. Instead, Cognitive Behavioral Therapy (CBT) has emerged as one of the most evidence-based and widely used treatments. The National Library of Medicine (NLM) recognizes CBT, along with Exposure and Response Prevention (ERP), as effective therapeutic approaches for managing Trichotillomania.
This type of therapy involves changing thought patterns to then alter your behaviors. CBT can be used to determine the dysfunctional beliefs you have related to hair pulling, along with helping you to accept your impulse to pull your hair without acting on it.
Habit Reversal Training
The type of CBT most commonly used for Trichotillomania is called habit reversal training. This is focused on changing a specific damaging habit, replacing it with a less harmful behavior. Habit reversal training often includes:
Identifying the triggers of your hair pulling and figuring out how to avoid them if possible
Recording your hair pulling activity in a diary
Engaging in another behavior when you feel like pulling your hair, such as playing with a fidget toy
It can also be helpful to tell loved ones about your condition, as having support from others can make people with Trichotillomania feel less alone in their struggle.
Tips for Coping with Trichotillomania
If you suffer from Trichotillomania, it’s highly recommended to see a mental health professional and pursue treatment. However, there are a number of things one can do on their own to combat the urges and negative impacts inherent in Trich. Some ways to cope with Trich include:
Finding a replacement behavior for pulling hair, like squeezing a stress ball, using a fidget toy, or squeezing your hand into a fist
Wearing a bandana or tight hat to make hair less accessible
Cutting your hair short
Putting band aids on your fingertips
Repeating a mantra or saying instead of following the urge to pull your hair out
Using breathing techniques to fight the urge to pull your hair
Coping with stress by exercising, taking a bath or doing self-care
As helpful as these techniques can be, the support of a therapist can be key in combating the urge to pull your hair out.
Services We Offer for Trichotillomania
Cognitive Behavioral Therapy (CBT)
CBT is one of the most effective approaches for treating Trichotillomania. At our Manhattan center, we use CBT to help clients recognize the thoughts, emotions, and triggers connected to their hair-pulling behavior. Sessions often include habit reversal training, a targeted behavioral method that teaches individuals how to:
Identify situations and feelings that lead to hair pulling
Interrupt the urge with healthier, competing responses
Track progress and develop greater self-awareness
CBT supports long-term change by helping clients build practical tools they can apply in real time.
Exposure and Response Prevention (ERP)
For clients whose Trichotillomania is linked to OCD or anxiety, ERP can be an effective part of therapy. This method involves exposing the individual to internal or external triggers, such as specific thoughts, situations, or urges, without engaging in the hair-pulling behavior. Over time, ERP reduces the emotional intensity of these triggers and strengthens the ability to tolerate discomfort without acting on it.
Take the First Step Toward Relief
Living with Trichotillomania can feel overwhelming, but you don’t have to manage it on your own. Effective treatment is available, and lasting change is possible. At our Manhattan center, we help individuals like you regain control, reduce shame, and improve their daily lives through evidence-based therapy.
If you’re ready to explore meaningful support and proven treatment options for Trichotillomania, we’re here to help.
Contact us today to schedule a consultation with one of our experienced therapists.
Frequently Asked Questions
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Cognitive Behavioral Therapy (CBT), especially Habit Reversal Training (HRT), is the most effective treatment for Trichotillomania. It helps individuals recognize triggers, build awareness, and replace hair-pulling with healthier behaviors. Exposure and Response Prevention (ERP) can also be helpful, particularly when Trich is related to anxiety or obsessive-compulsive tendencies.
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Yes, Trichotillomania is often linked to anxiety and obsessive-compulsive disorder (OCD). Many people with Trich experience rising tension before pulling and relief afterward, which mirrors OCD behavior patterns. While not the same condition, Trich can co-occur with OCD and benefits from similar therapeutic approaches like CBT and ERP.
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Trichotillomania usually does not go away on its own. Without treatment, the behavior can become more frequent or severe over time, especially during stressful periods. Professional therapy provides tools to manage and reduce hair-pulling behavior effectively, improving emotional health and quality of life in the long term.
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Triggers for Trichotillomania often include stress, anxiety, boredom, fatigue, or emotional discomfort. Some people pull consciously to relieve tension, while others do so automatically. Identifying personal triggers is a key part of therapy, allowing individuals to interrupt the cycle and replace the behavior with healthier coping strategies.
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If hair-pulling leads to distress, noticeable hair loss, or disruption in daily life, professional help is recommended. Trichotillomania is more than a habit, it’s a recognized mental health disorder. Treatment can reduce symptoms, improve coping, and restore a sense of control over your behaviors and emotional well-being.