How to Talk to Your Doctor About Trichotillomania

Telling a doctor that you pull out your own hair can feel like one of the hardest sentences to say out loud. Many people hide it for years. If you’re reading this before an appointment, or wondering whether to book one, this guide is for you.

It covers how to talk to your doctor about trichotillomania (trich): what to say, what the doctor might ask or check, and what to do if they haven’t heard of it. There’s also a one-page note you can fill in and take with you.

Trichotillomania is a recognised condition that affects about 1 in 50 people. 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 or a lack of willpower.

What should I say to my doctor about hair pulling?

Say it plainly, near the start: “I pull out my hair, and I can’t stop.” Doctors have only a few minutes, and opening with the real reason for your visit means the time goes on what matters. You don’t need to use the word trichotillomania, though it helps if you know it.

Then add a few details:

Where you pull from: scalp, eyebrows, eyelashes, beard or other areas
How long it’s been going on, and roughly when it started
How often, and whether it happens without you noticing or in response to an urge or tension
What you’ve tried to stop, and what happened
How it affects you: time lost, avoiding people or places, hiding hair loss, feeling low or anxious
Whether you chew or swallow hair, even sometimes

Some sentences people find useful:

“This is hard for me to talk about, so I’ve written some notes.”
“I think this might be trichotillomania. Could you help me find out?”
“I’d like help to stop, not just to cover the hair loss.”

Doctors’ reference guides note that people with trich usually say the hair loss comes from pulling when a doctor asks directly. Saying it first spares you the wait for the right question.

You may find it easier to understand your own pulling before you go. Our guide to trichotillomania symptoms explains the signs doctors look for.

Our self-check can help you put what happens into words.

Who should I see first?

Start with your GP. In England you can also refer yourself to NHS Talking Therapies without seeing a GP first, if you’re 18 or over (16 in some areas). Some local services list hair pulling among the problems they help with. A GP visit is still useful to rule out other causes of hair loss and, if needed, to refer you on. Elsewhere in the UK, start with your GP.

If the first person you see is a skin doctor (dermatologist), tell them you pull the hair. That changes what they look for.

How do I prepare to talk to my doctor about trichotillomania?

Write a few lines down beforehand, and bring them with you. When you’re nervous it’s easy to leave with the most important thing unsaid. You can read from your note or simply hand it over.

A few more things help:

Book a longer appointment if your practice offers one, or tell the receptionist it’s about a mental health concern.
Take someone with you if you’d like support.
Decide what you’re comfortable showing. The doctor may want to look at the area. You can say if you’d prefer not to remove a wig, hat or make-up today, and ask what they need to see.

A few lines written down beforehand make it easier to say what you came to say.

About my hair pulling: a note for my doctor

I’d like to talk about hair pulling. I find it hard to say out loud, so I’ve written it down.

I pull hair from:
I’ve been pulling since about:
It happens (how often, when, where):
I’ve tried to stop by:
It affects my life by:
I sometimes chew or swallow hair: yes / no
My mood lately:

My questions

Could this be trichotillomania (hair-pulling disorder)? It is listed in the DSM-5 group of obsessive-compulsive and related disorders, ICD-10 code F63.3.
Could anything else be causing my hair loss?
Can you refer me to someone who treats it, for example with behavioural therapy such as Habit Reversal Training?
Can you add this to my medical record?

What might the doctor ask or check?

Expect questions and a look at the area, and usually no tests. There’s no blood test or scan that shows trichotillomania. A doctor makes the diagnosis from what you tell them and what they see.

They may ask:

How long you’ve been pulling, and whether you’ve tried to stop
Whether pulling upsets you or gets in the way of daily life
Whether you feel tension or an urge before pulling, or relief after
About your mood, stress, sleep and general health
Whether you chew or swallow hair

They may check:

What they do	Why
Look at the scalp, brows, lashes or other areas	To see the pattern of hair loss and rule out other causes
Look closely with a lit magnifier (a dermatoscope)	This close look is called trichoscopy. A 2021 review found several signs in the hairs themselves that point clearly to pulling
Rarely, take a tiny skin sample (a biopsy)	Only if they need to rule out another cause of hair loss
Order a blood test or scan	Usually only if you’ve swallowed hair, to check for a blockage or anaemia (too few red blood cells)

The main conditions doctors want to rule out are other causes of hair loss, such as alopecia areata (an immune condition where hair falls out in patches) and skin infections. Our guide to trichotillomania and alopecia explains how doctors tell them apart.

What if my doctor hasn’t heard of trichotillomania?

It happens, and it isn’t a reason to give up. Trich is common, but many doctors get little training in it.

In a 2006 survey of almost 1,700 people with trich, about 28% of those who’d had treatment said their provider knew nothing about it. Only about 15% said their provider knew a lot.
In a 2023 survey of 329 mental health providers in Utah, about half had never treated anyone for trich.
In a 2021 study, 20 adults from 15 countries described doctors who didn’t know the condition. Some saw several before anyone named it.

If your doctor seems unsure:

Name it and give a source. “I think this is trichotillomania, or hair-pulling disorder. It’s in the DSM-5.” You could show them the NHS or IOCDF (International OCD Foundation) page on your phone.
Ask for what you need. A referral, a note in your record, or a follow-up appointment once they’ve read up.
Ask to see another doctor at the same practice if you feel dismissed. You’re allowed to.
Look for help yourself too. You don’t always need a referral to see a therapist or practitioner.

If a doctor or therapist has reacted badly before, that says more about their training than about you. An appointment with someone else can go very differently.

What happens after the appointment?

Usually, a referral or a plan to find therapy. The treatment with the most research behind it is talking therapy based on Habit Reversal Training (HRT). HRT teaches you to notice when you’re about to pull and to do something else with your hands instead. The NHS notes that antidepressants are not usually prescribed for trich.

A doctor can rule out other causes and point you towards therapy, in person or online.

Waiting lists can be long, and not every service knows trich. You can look for someone who understands hair pulling at the same time.

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.

For an overview of every option and the evidence behind each, see our guide to trichotillomania treatment.

You can read more about the condition itself in our complete guide to trichotillomania.

Our guide to eating hair explains the warning signs in more detail.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 999 or go to your nearest emergency department.

Samaritans — 116 123 (www.samaritans.org)

Questions people ask

Can a GP or family doctor diagnose trichotillomania?

Yes. There’s no blood test or scan for it, so any doctor can make the diagnosis by asking about your pulling and looking at the area. Some people are later seen by a skin doctor or a mental health professional, especially if the cause of hair loss isn’t clear.

Should I see a dermatologist or a GP first?

Start with your usual doctor in most cases. They can examine the hair loss, rule out common causes and refer you on. If a skin doctor (dermatologist) is the first person you see, say clearly that you pull the hair, so they don’t look only for other kinds of hair loss.

Do I need a diagnosis before I can get therapy?

Not always. Many therapists and practitioners will see you without a doctor’s letter, and in England you can refer yourself to NHS Talking Therapies. A doctor is still worth seeing to rule out other causes of hair loss, and some health systems need a referral before they pay for therapy.

Will my doctor prescribe medication for hair pulling?

Probably not as a first step. The NHS says antidepressants are not usually prescribed for trichotillomania, and no medication is licensed specifically for it. Talking therapy based on Habit Reversal Training has the most research behind it. Ask your doctor about any medicine or supplement before trying it.

Can I take someone with me to the appointment?

Yes. A friend, partner or family member can come in with you, help you remember what was said, or read out your note if you get stuck. Tell the receptionist or the doctor at the start that you’d like them there.

What if I cry or freeze during the appointment?

That’s common, and doctors see it often. Pause, breathe, and hand over your written note. You can also say, “This is hard for me to talk about.” Naming the difficulty usually makes the rest of the conversation easier.

Can I talk to a doctor about hair pulling online?

Yes. Many practices offer phone or video appointments, which some people find easier for a first conversation. The doctor may still ask to see the area of hair loss, either on camera or at a follow-up visit.