Trichotillomania (hair-pulling disorder)

Key takeaways

• Trichotillomania is a body-focused repetitive behaviour: repeatedly pulling out your own hair despite trying to stop, causing hair loss and distress. It sits between psychiatry and dermatology, and onset is typically in childhood or adolescence (DuBois 2025).
• It is not a habit you can just stop. It carries significant psychiatric comorbidity and functional impairment (DuBois 2025).
• The best-supported treatment is behavioural: habit reversal training, and acceptance-and-commitment therapy (ACT) combined with it. A 2026 meta-analysis of 29 randomized trials found strong support for habit reversal training, ACT-enhanced habit reversal and N-acetylcysteine, found therapies including habit reversal beat those without it, and did not consistently support clonazepam (Fisak 2026).
• No drug is FDA-approved for it (Christensen 2023). The 2021 Cochrane review (12 mostly small studies) found limited evidence for medication (Hoffman 2021).
• Digital therapy helps to a degree. A 2026 meta-analysis of 14 studies (5,468 people) on hair pulling and skin picking found large before-and-after gains (g = 1.01) and a medium advantage over control in randomized trials (g = 0.63), higher with ACT content and accountability features (Barber 2026).
• In children, a 2026 systematic review of 10 studies found behavioural interventions, especially habit reversal, helped most, while evidence for SSRIs and N-acetylcysteine was weak or variable (Sharifi 2026).
• Relapse is common in adults, so plan for maintenance (DuBois 2025).

What it is

Scalp is pulled most often, but eyebrows, lashes, beard and body hair can be too. Pulled areas usually show irregular loss with broken hairs of different lengths rather than the smooth, sharply bordered patches of alopecia areata. Some people swallow hair, and rarely a hair ball forms in the gut. Diagnosis is clinical, supported by scalp microscopy and sometimes a biopsy. A dermatologist should rule out look-alikes such as alopecia areata, tinea capitis and scarring alopecia.

What the studies show

• Habit reversal training: several randomized trials and meta-analyses.
• N-acetylcysteine: supported in the 2026 meta-analysis, though the earlier Cochrane review was uncertain. It is a supplement in many countries, and doses varied across trials.
• SSRIs and clonazepam: weak or inconsistent.
• Hair-care products and supplements: no data. No hair-growth drug has been tested as a treatment; the behaviour is the target.

Hair type notes

• All hair types are affected. In curly hair, pulled areas may be disguised by shrinkage and styling, delaying recognition, while tight styles may be wrongly blamed, so pattern and history matter.
• After pulling stops, regrowth follows the normal hair cycle (see hair growth cycle); follicles are usually undamaged unless pulling is chronic, when permanent thinning can occur.

Bottom line

Seek a clinician trained in habit reversal or ACT, and ask a dermatologist to exclude other causes. Self-guided digital programmes can help where therapists are scarce. Fidget tools and barriers such as gloves are part of habit reversal training. For children, involve parents and a paediatric dermatologist or psychologist, and avoid shaming. Seek urgent help for abdominal pain or vomiting with hair swallowing. See when to see a dermatologist. Discuss with a doctor.