Do I Have Trichotillomania? A Quick Self-Check

If you keep pulling out your hair and wonder whether it’s more than a habit, this page is for you. Trichotillomania (trik-o-til-o-MAY-nee-uh), or trich, is a condition where people repeatedly pull out their own hair and find it very hard to stop. It’s a body-focused repetitive behaviour (BFRB), one of a group of conditions where people repeatedly pull, pick or bite at their hair, skin or nails. It isn’t a bad habit, a lack of willpower or self-harm.

Below is a two-minute self-check built around the signs doctors use, then what a doctor looks for and what to do next.

Do I have trichotillomania?

You may have trichotillomania if four things are true: you keep pulling out your hair, it has caused some hair loss, you’ve tried more than once to stop, and it upsets you or gets in the way of your life. Only a doctor or therapist can diagnose it, because they also need to rule out other causes of hair loss.

Answer each statement for the last few months. Your answers stay on this page. Nothing is saved or sent.

I pull out my own hair, from my scalp, eyebrows, eyelashes, beard or anywhere else on my body, and I keep going back to it.
My pulling has left gaps, thin areas or missing hairs, even if I cover them or no one else would notice.
I’ve tried more than once to cut down or stop pulling.
Pulling upsets me, or it gets in the way of things like work, school, friendships, relationships or doing things I enjoy.
I often feel an urge, itch or tension before I pull, or relief or satisfaction afterwards.
Sometimes I only realise I’ve been pulling afterwards, when I see hair on my lap, desk or pillow.
I search for certain hairs to pull, or I look at, play with or bite the hair after pulling it.
I sometimes chew or swallow hair I’ve pulled.
A doctor has told me I have a skin or scalp condition, or I find hair coming out in patches without pulling it.
I remove hair mainly to fix something I strongly dislike about the way I look.

What your answers might mean

If you answered yes to all of questions 1 to 4

Your answers match the main signs of trichotillomania. That isn’t a diagnosis, because a doctor also needs to check that nothing else is causing the hair loss. But it’s a strong reason to talk to someone. You’re far from alone, and trich responds to the right help.

If you answered yes or not sure to question 1, but not yes to all of questions 1 to 4

Your answers match some of the signs. You don’t have to tick every box for pulling to be worth taking seriously. Note when and where you pull for a week or two, then share it with a doctor or a practitioner who understands hair pulling.

If you answered no to question 1

Your answers don’t point to trichotillomania. If you’re losing hair but not pulling it out, something else is more likely to be causing it, such as alopecia areata or a fungal infection of the scalp. A doctor can look at your hair and scalp and find out.

If you answered yes to any of questions 5 to 7

You also recognised some common patterns. Urges and relief, pulling on autopilot, and rituals like searching for certain hairs are common in trichotillomania. They aren’t needed for a diagnosis, but they’re useful to mention, because they show what drives your pulling.

If you answered yes or not sure to question 8

Please mention swallowing hair to a doctor. Swallowed hair can build up in the stomach over time. See a doctor soon if you also have stomach pain, feel or are sick, or are constipated.

If you answered yes or not sure to question 9

Ask a doctor to check for other causes too. A skin or scalp condition, or hair coming out without pulling, is worth having a doctor look at.

If you answered yes to question 10

Pulling to fix your appearance can point to a different condition. It can be a sign of body dysmorphic disorder (BDD), where people are very distressed by a flaw in their appearance that others often can’t see. A doctor or therapist can help you work out which fits.

Whatever your answers

This self-check is not a diagnosis. It puts the signs in the DSM-5 into plain words, it isn’t a clinical scale, and it can’t see your hair or scalp. If pulling bothers you, whatever your result, you deserve support.

What signs does a doctor look for?

A doctor looks for the same four signs as the self-check, then makes sure nothing else explains the hair loss. The signs come from the DSM-5, the manual doctors in the US and many other countries use to diagnose mental health conditions. The doctor checks that:

You pull out your hair again and again, and it leads to hair loss. The loss can be hidden, or just thinner hair. It doesn’t have to be a bald patch.
You’ve tried more than once to cut down or stop.
It causes you real distress, or gets in the way of your life. For many people, that’s shame and the effort of hiding it.
Nothing else explains it. That means no skin or medical condition causing the hair loss, and no other mental health condition that fits better, such as body dysmorphic disorder.

Pulling again and again, trying to stop, feeling it matters, and other causes ruled out: the four things a doctor looks for.

Our guide to trichotillomania in the DSM-5 and ICD explains the criteria and codes in more detail.

At an appointment, a doctor may:

What the doctor may do	Why
Ask when, where and how you pull, and whether you’ve tried to stop	To match your experience to the four signs
Ask whether you chew or swallow hair	Swallowed hair can build up in the stomach
Look at the areas where hair is missing	Pulling usually leaves irregular, stubbly patches with hairs of different lengths
Gently tug a small bunch of hair (a pull test)	In trichotillomania, hairs around the patch don’t come loose easily
Check for a fungal infection, sometimes with a special lamp	To rule out an infection that causes patchy hair loss
Look at your scalp through a magnifying camera (trichoscopy)	Hairs broken at uneven lengths and split ends are typical of pulling
Sometimes take a tiny skin sample (a biopsy)	To rule out other causes of hair loss

Trich is a mental health condition, but dermatologists (skin doctors) often make the diagnosis. They take particular care to rule out alopecia areata, where the immune system attacks hair follicles and hair falls out in patches. Our guide to telling trichotillomania and alopecia apart covers the differences.

Telling a doctor is often the hardest part. It helps to say it plainly: “I pull out my hair and I can’t stop.” Our guide to talking to your doctor about hair pulling has more words you can use.

What if I don’t tick every box?

You can still have trichotillomania, and you can still get help. Many people rule themselves out for reasons that don’t count:

You don’t need bald patches. Hair loss from pulling is often hidden, or shows only as thinner hair.
You don’t need to feel an urge or relief. Many people do, but a study that tested the DSM-5 criteria found not everyone does, so it isn’t part of the definition.
Any body hair counts, not just the scalp, and the places you pull from can change over time.
Pulling without noticing counts. Some people pull mostly on autopilot, others with full awareness, and many do both.

Grooming is different: shaping your brows for the way you want to look isn’t trich.

Our guide to focused and automatic pulling explains the two styles and why they matter.

If you don’t meet every sign but pulling still bothers you, it’s worth talking to someone. Our guide to trichotillomania symptoms goes through the signs in more detail.

What should I do if this sounds like me?

Take one small step: note what’s happening, then talk to a doctor or to a practitioner who understands hair pulling. You don’t have to wait until it feels “bad enough”.

Write it down. For a week or two, note when and where you pull and how you were feeling. It makes a first appointment easier.
Talk to a doctor. A doctor can check for other causes of hair loss.

Your GP is a good place to start.
Find someone who understands trich. Not every therapist has worked with hair pulling, so it helps to look for someone who has. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory. Our guide to finding a therapist who understands trichotillomania explains what to ask on a first call.
Start practical steps now. You don’t need a diagnosis to begin. The approach with the most research behind it is Habit Reversal Training (HRT), a type of cognitive behavioural therapy that teaches you to notice when you pull and do something else with your hands. Our guide to how to stop pulling your hair has steps you can try today.

Write it down, talk to a doctor, find someone who understands hair pulling. Small steps, one at a time.

If you’re a teenager, you could show this page to a parent, school nurse or doctor you trust. If you’re a parent reading this about your child, The Parent’s Guide to Trichotillomania is about understanding what your child is going through.

When should I get help straight away?

See a doctor soon if you swallow pulled hair and have stomach problems, and talk to someone today if you feel very low.

Low mood often comes alongside trich, and hiding it for years is exhausting. If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 000 or go to your nearest emergency department.

Lifeline — 13 11 14 (www.lifeline.org.au)

Questions people ask

Can an online test tell me for sure if I have trichotillomania?

No. An online check like this one can show whether your experience matches the main signs, but it can’t rule out other causes of hair loss. Only a doctor or therapist can diagnose trichotillomania, usually by talking with you and, if needed, looking at the areas where hair is missing.

Does it count as trichotillomania if I only pull a few hairs?

It can. There’s no minimum number of hairs or hours. What matters is that you keep pulling, it leads to some hair loss, you’ve tried to stop, and it bothers you or affects your life. Pulling the odd stray hair now and then, with no struggle to stop, isn’t trichotillomania.

Is plucking my eyebrows to shape them the same as trichotillomania?

No. Shaping your brows or tidying stray hairs for the way you want to look is grooming. Trichotillomania pulling isn’t done to improve your appearance, and it keeps happening even though you want to stop. If shaping often turns into pulling you can’t stop, that’s worth mentioning to a doctor.

Can teenagers use this self-check?

Yes. It’s written for teenagers and adults, and trich most often starts between the ages of 10 and 13. If you’re under 18, show your answers to a parent, school nurse or doctor you trust. For younger children, parents should talk to a doctor; pulling in toddlers often stops on its own.

Will a doctor need to take a sample of my skin or hair?

Usually not. Most of the time a doctor can tell from talking with you and looking at the area. A dermatologist (skin doctor) may look through a magnifying camera. A tiny skin sample, called a biopsy, is sometimes taken to rule out other causes of hair loss.

Can I get help without a diagnosis?

Yes. You don’t need a formal diagnosis to start practical strategies, and many practitioners will see you based on what you tell them. If pulling bothers you, that’s reason enough to talk to someone who understands hair pulling.

What’s the difference between trichotillomania and alopecia?

Alopecia is the general word for hair loss. In alopecia areata, the immune system causes hair to fall out in patches. In trichotillomania, hair loss comes from pulling. Doctors take care to tell them apart, often by looking closely at the hairs around the patch.