Trichotillomania, or hair-pulling disorder, can be surprisingly difficult to talk about. Many people hide their hair pulling, camouflage areas of hair loss, and avoid telling even people they love. Shame can become one of the most painful parts of the disorder. Specialized behavioral treatment for trichotillomania can help you understand your individual pulling patterns, develop strategies for managing urges, and regain a sense of control.
If you have been pulling your hair for years, you may have become very good at hiding it.
You may know exactly how to style your hair to cover a thin area. You may avoid certain lighting, mirrors, hair salons, swimming pools, or intimate situations. You may wear your hair differently depending on who you are going to see. You may have explanations ready for a bald spot or thinning area.
And you may have promised yourself countless times that you were going to stop.
Yet you keep pulling.
By the time someone seeks treatment for trichotillomania, the hardest part may not be finding a therapist. It may be admitting to another person what has been happening in private.
When You Are at Your Wits’ End With Hair Pulling
One of the most frustrating things about trichotillomania is knowing that you want to stop and still finding yourself pulling.
You may have tried to use willpower. You may have put your hands under a pillow, worn a hat, cut your nails, kept your hands busy, or made a promise that you would never pull again.
Sometimes these strategies work temporarily. Then the urge returns.
Hair pulling can be automatic, meaning it happens with little awareness, or focused, meaning you are consciously seeking a particular hair or sensation. Some people experience both. Pulling can be associated with boredom, tension, anxiety, frustration, fatigue, or other emotional states, but it can also provide a satisfying sensory experience that makes the behavior difficult to interrupt.
This is one reason telling yourself to “just stop” is rarely enough.
Trichotillomania is not simply a bad habit or a failure of self-control.
Why Is Trichotillomania So Embarrassing to Talk About?
Hair pulling can feel intensely personal because the consequences may be visible.
You may worry that someone will notice your hair loss. You may fear that a partner will see what you have been hiding. You may feel embarrassed sitting in a therapist’s office and saying, “I pull out my hair.”
Some people conceal their pulling for years.
The secrecy can become extensive: avoiding salons, changing hairstyles, wearing wigs or extensions, covering thinning areas, avoiding photographs, or declining activities where other people might notice the hair loss. Shame and embarrassment can also lead people to withdraw socially or avoid seeking professional help.
And there is another layer to the shame.
You may think:
Why can’t I control something as simple as my own hands?
The answer is that trichotillomania involves repetitive behavioral and sensory patterns that can be surprisingly powerful. Understanding those patterns is much more useful than criticizing yourself for having them.
Shame Can Become Part of the Problem
For some people, a difficult cycle develops:
urge or trigger → pulling → temporary relief or satisfaction → regret or shame → attempts to hide the behavior → increased distress → another episode of pulling
That cycle does not mean that anxiety is always the cause of hair pulling. Trichotillomania is different for every person.
The important point is that shame does not necessarily make the behavior easier to control.
In fact, when you are spending enormous amounts of energy hiding the problem, there is less opportunity to understand what is actually happening.
Treatment begins by replacing secrecy and self-criticism with curiosity.
What If I Am Too Embarrassed to Tell a Therapist?
This is a common concern people have when considering treatment for trichotillomania.
You may wonder:
- What if the therapist thinks this is strange?
- What if they don’t understand?
- What if they tell me to use willpower?
- What if I show them how much hair I’ve lost?
- What if I’ve been pulling for 10 or 20 years and nothing can help me now?
A therapist who treats trichotillomania should not be shocked or judgmental.
Instead, the goal is to understand your particular pattern.
When does pulling happen? Where do you pull? Are you aware of it while it is happening? What sensations do you experience before and after pulling? Are there particular times, places, emotions, or activities associated with it? What have you already tried?
These questions are not designed to make you feel exposed. They help identify the behavioral and sensory components that treatment can target.
What Does Treatment for Trichotillomania Actually Look Like?
Evidence-based treatment for trichotillomania commonly includes behavioral approaches such as Habit Reversal Training (HRT), along with other individualized cognitive and behavioral strategies. HRT relies on awareness training, competing response training (physically incompatible behaviors that block pulling), and stimulus control (modifying physical surroundings to interrupt urges).
I also use the Comprehensive Model for Behavioral Treatment (ComB) when appropriate. ComB looks at the individual factors that maintain a person’s body-focused repetitive behavior (BFRB) rather than assuming that every person pulls for the same reason.
For example, consider a client who tells me that she does most of her pulling while sitting on the couch at night.
Initially, she may describe it simply as, “I don’t know. I just start pulling.”
Instead of telling her to stop, we slow the behavior down and examine it.
What is she doing immediately beforehand? Is she watching television? Is her hand already near her hair? Is she looking for a particular texture? Is she tired? Is she trying to relax after a stressful day? Does she notice the urge before her hand moves, or only after she has already pulled several hairs?
We might then introduce greater awareness of the sequence, modify the environment, use stimulus-control strategies, and develop competing responses that address the specific sensory or behavioral needs involved.
The goal is not simply to say, “Don’t pull.”
It is to make the behavior understandable enough that you can begin to change it.
Learn more about related treatment approaches:
- Cognitive Behavioral Therapy (CBT)
- OCD & Related Disorders Treatment
- Advanced Behavioral Health: Trichotillomania and BFRBs
- Cleveland Clinic:Trichotillomania
What If I Have Had Trichotillomania for Years?
Longstanding trichotillomania does not mean that treatment is pointless.
Trichotillomania can be chronic, with symptoms that fluctuate over time, and many people experience repeated attempts to stop.
It is also important to recognize that progress does not have to mean being perfect immediately.
Treatment may begin with becoming more aware of pulling that previously happened automatically. It may involve reducing the number of episodes, increasing your ability to interrupt an urge, spending less time pulling, or feeling less controlled by the behavior.
For some people, these changes eventually lead to substantial improvement.
Most importantly, you no longer have to organize your life around hiding the problem.
Asking for Help Is Not Something to Be Ashamed Of
If you have spent years hiding your hair pulling, making an appointment can feel like a very big step.
You do not need to arrive at therapy with a perfect explanation.
You do not need to know exactly why you pull.
You do not need to have stopped pulling before you seek treatment.
And you certainly do not need to be embarrassed that previous attempts to stop have not worked.
The first step is simply being willing to look at what is happening.
Frequently Asked Questions About Trichotillomania
Q: Is trichotillomania a mental health condition or just a bad habit?
A: Trichotillomania, also called hair-pulling disorder, is a recognized mental health condition involving recurrent hair pulling and repeated attempts to decrease or stop the behavior. It is classified among the obsessive-compulsive and related disorders.
Q: How do you stop pulling your hair?
A: Stopping hair pulling involves identifying individual triggers and behavioral patterns rather than relying on willpower alone. Evidence-based treatments like Habit Reversal Training (HRT) and ComB use targeted awareness training, stimulus control (altering environments to make pulling harder), and competing response training (engaging your hands in non-destructive physical actions when urges strike) to interrupt the cycle.
Q: Can trichotillomania be treated if I have been pulling for many years?
A: Yes. A long history of hair pulling does not mean that treatment cannot help. Behavioral treatments such as Habit Reversal Training and individualized approaches such as ComB are used to help people understand and manage their pulling patterns over time.
Q: What if I am too embarrassed to tell a therapist about my hair pulling?
A: That embarrassment is understandable, particularly when you have spent years hiding the behavior. A therapist experienced in trichotillomania should be familiar with the shame and secrecy that often accompany Body-Focused Repetitive Behaviors (BFRBs). You do not have to explain everything perfectly at the first appointment.
Specialized Treatment for Trichotillomania
If you have been hiding your hair pulling for years, asking for help may feel uncomfortable – but you do not have to navigate it alone. Specialized behavioral treatment for trichotillomania can give you practical, compassionate tools to interrupt pulling patterns, manage urges, and break free from the burden of secrecy.
Dr. Suzanne Feinstein is a Columbia University-trained licensed clinical health psychologist who provides specialized cognitive behavioral treatment for trichotillomania and other Body-Focused Repetitive Behaviors (BFRBs), incorporating Habit Reversal Training, stimulus control, and the Comprehensive Model for Behavioral Treatment (ComB).
If you are ready to explore evidence-based trichotillomania treatment in a confidential, non-judgmental setting, reach out today. To schedule an initial consultation with Dr. Suzanne Feinstein, call 646-345-3010 or visit Advanced Behavioral Health.