Trichotillomania and Autism: Is Hair Pulling Stimming?

If you’re autistic and you pull your hair, or you’re a parent of an autistic child who does, you may have heard two different things. One person calls it stimming and says to leave it alone. Another calls it trichotillomania and says it needs treatment. Both can be right, sometimes at the same time.

This guide explains how the two overlap, how to tell them apart, and what helps. It uses identity-first language (“autistic people”), which many autistic adults prefer. Being autistic isn’t something to fix. Hair pulling that causes hair loss, pain or distress is worth support.

Is hair pulling a form of stimming?

Sometimes. Stimming means repeated movements or actions that help a person feel calm, enjoy a sensation or show a feeling. Hand flapping, rocking, spinning and rubbing textures are common stims. Twirling, stroking or sniffing hair can be stims too, and they’re usually harmless.

Autistic people often describe stimming as a way to soothe themselves and manage strong feelings. The American Psychiatric Association and the UK’s National Autistic Society both say harmless stims shouldn’t be stopped. Forcing someone to stop can make anxiety and distress worse.

Hair pulling becomes more than a stim when hair comes out, patches appear, or the person wants to stop and can’t. At that point it may be trichotillomania. Trich is a body-focused repetitive behaviour (BFRB), one of a group of conditions where people repeatedly pull, pick or bite at their own hair, skin or nails. It isn’t a bad habit and it isn’t a lack of willpower.

Some autism organisations group harmful hair pulling with self-injurious behaviour, meaning behaviour that causes injury. That doesn’t mean the person is trying to hurt themselves. In trichotillomania, pulling brings relief or satisfaction, and the hair loss is a side effect, not the goal.

How do I tell the difference between stimming and trichotillomania?

Look at what the behaviour does for the person and what it leaves behind. There’s no test that separates the two, and they can overlap, but some patterns help.

Doctors diagnose trichotillomania when someone keeps pulling out their hair, has tried to stop or cut down, and is distressed by it or finds it gets in the way of daily life. The doctor also checks that another condition doesn’t explain the pulling better. So they may ask whether the pulling is part of a wider pattern of stims, or something separate.

Two things are easy to miss. Autistic people may find it hard to describe urges or feelings, so “Do you want to stop?” may not get a clear answer. And very young children often pull hair when they’re tired or upset, and many grow out of it. Our guide to toddler hair pulling covers that age group.

Why might autistic people pull their hair?

The reasons are often sensory. Many autistic people are very sensitive to touch, sound or light, or seek out strong sensations. Pulling can give a precise feeling: the texture of a coarse hair, the small tug as it comes out, the feel of the root between the fingers.

People with trich often have sensory differences too, whether or not they’re autistic. In the 2018 study above, adults with trich were more sensitive to touch and sound than people without it, and those who were more sensitive also tended to be more perfectionist. Our guide to why pulling hair feels good explains the sensations many people seek.

Pulling can also calm overload, fill quiet or boring moments, or ease anxiety. Many people pull on autopilot, while reading, scrolling or lying in bed. There’s more on automatic and focused pulling in our complete guide to trichotillomania.

What helps autistic people who pull?

What helps most is meeting the need behind the pulling in a safe way, not banning the behaviour. Research specific to autism is still small, but it points in the same direction as research on trich in general.

Find the pattern first. Keep a simple log for a week or two: when pulling happens, where, what was going on, and how the person seemed. Look for sensory triggers such as noise, labels, bright light or boredom. Visual logs with pictures or colours may work better than words.

Offer swaps that give the same feeling. The National Autistic Society suggests replacing a harmful stim with a safe one that meets the same sensory need. For pulling, that might be:

• Texture: a hook-and-loop fastener strip, a textured fidget, a knotted fabric cord
• The tug: stretchy putty, a pull toy, peeling a sticker
• Pressure: a weighted lap pad, a firm hug if the person wants one, squeezing a stress ball
• Scalp feeling: a firm hairbrush or a scalp massager
• Mouth: a chewable necklace or crunchy food, if chewing or biting hair is part of it
• Less input: headphones, a quiet corner, softer lighting

Keep swaps where pulling happens, and let the person choose. Our guide to fidget toys and tools matches tools to different urges.

Try an adapted habit reversal approach. Habit Reversal Training (HRT) is a therapy with the most research behind it for trich. It teaches you to notice when you’re about to pull and to do something else with your hands instead. In a 2026 pilot study, school staff used habit reversal combined with daily sensory strategies with eight autistic students aged 8 to 14. Pulling dropped for every student and stayed lower at follow-up. Another 2026 study adapted habit reversal for four autistic people with harmful repetitive behaviours, with encouraging early results. Both studies were small, so larger trials are needed. You can read more in our guide to Habit Reversal Training.

Ask for therapy that fits. NICE, which writes health guidance in England, recommends adapting talking therapies for autistic adults. That includes a clear structure, written and visual materials, plain words without metaphors, a focus on changing behaviour, regular breaks, and involving a family member or supporter if the person agrees.

Keep it kind. Telling someone off, pointing out every pull or forcing their hands still adds shame and stress, and both feed pulling. A calm, private signal agreed in advance works better.

Some autistic people also have ADHD, which can add to fidgeting and pulling. Our guide to trichotillomania and ADHD covers that overlap.

When should I get help?

Get support if pulling is causing hair loss, sore or broken skin, distress, or problems at school, work or home. You don’t need to wait until it’s “bad enough”, and you don’t need an autism diagnosis first.

If the person doesn’t use speech, or pulling started suddenly, see a doctor first to check for pain, itching or illness. New pulling can be a way of showing that something hurts.

Look for someone who understands hair pulling and has experience with autistic people. Some autistic people find online sessions easier, so ask whether that’s an option. You can search the directory and ask about autism experience on a first call. If your child pulls, our guide for parents of children with trichotillomania covers what to say and what to avoid.

For a steady, step-by-step way to support your child, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

If you or your child are feeling very low or overwhelmed, 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

Sources

1. Grant, J.E. & Chamberlain, S.R. (2022). Autistic traits in trichotillomania. Brain and Behavior, 12(7).
2. Falkenstein, M.J., Conelea, C.A., Garner, L.E. & Haaga, D.A.F. (2018). Sensory over-responsivity in trichotillomania (hair-pulling disorder). Psychiatry Research, 260, 207–218.
3. Aldakhil, A.F. (2026). Sensory-integrated habit reversal intervention for hair pulling and classroom engagement in children with autism: A multiple-baseline pilot study. Research in Developmental Disabilities, 169.
4. Majchrzak, J. & Dillenburger, K. (2026). Modified Habit Reversal for Restricted and Repetitive Behaviour in Autistic Young People. Single Case in the Social Sciences, 3(1), 41–55.
5. Pereyra, A.D. & Saadabadi, A. (2023). Trichotillomania. StatPearls. StatPearls Publishing.
6. American Psychiatric Association (2020). Understanding Stimming: Repetitive Behaviors with a Purpose.
7. National Autistic Society. Stimming.
8. National Institute for Health and Care Excellence (2012). Autism in adults: diagnosis and management (CG142), recommendation 1.6.3.