Trichotillomania Research Roundup: What New Studies Found

Trichotillomania research moves slowly, and most of it sits behind journal paywalls in language written for other researchers. This roundup picks out the studies from the past year that matter most to people with trichotillomania (trich), and to the parents and practitioners who support them, and explains each one in plain English.

This edition covers studies published between September 2025 and September 2026. For each one you’ll find what the researchers did, what they found and what it might mean for you.

Which new trichotillomania studies came out this year?

Seven studies stood out because they were large, well designed, or answered a question readers often ask.

What did the new studies find?

The biggest review of treatment trials so far

A team led by Fisak pooled the results of around 30 randomised controlled trials, the kind of study where people are assigned by chance to a treatment or a comparison group. This is called a meta-analysis. Three approaches came out with strong support because they worked well and had been repeated: behaviour therapy that includes habit reversal, habit reversal combined with acceptance and commitment therapy (ACT), and N-acetylcysteine (NAC).

Habit Reversal Training (HRT) teaches you to notice the first signs of pulling and to do something else with your hands instead. ACT teaches you to make room for urges and uncomfortable feelings without acting on them. NAC is a supplement that affects glutamate, one of the brain’s chemical messengers. Therapies that included habit reversal did better than those that didn’t. Some other treatments showed big effects in single trials, but those results haven’t been repeated yet.

You can read more about how these therapies work in our guide to trichotillomania treatment.

Online programmes that you work through yourself

Barber and colleagues reviewed 14 studies of digital help for trich and skin picking. These were websites and apps that teach behavioural skills, some with a therapist checking in and some entirely self-guided. Together, the studies included 5,468 people.

On average, symptoms dropped a lot, and the improvement lasted at least six months. Programmes beat comparison groups by a medium margin, and worked better with ACT skills and some accountability, such as someone checking on your progress. They did little for mood or quality of life, and the studies varied a lot in design.

What helps children and teenagers

Sharifi and colleagues looked at 10 studies from the past decade on treating trich in young people. Habit reversal gave the most benefit. SSRIs, a common type of antidepressant, gave mixed results in small reports, and results for NAC varied. The authors called for bigger studies in children.

If you’re a parent, this backs starting with a behavioural approach rather than medicine.

What comes before an urge

Gallinat and colleagues asked 61 adults with trich to answer short questions on their phones seven times a day for ten days. They logged their feelings, how strong their urges were, and whether they’d pulled. That gave 2,557 check-ins and 702 pulling episodes.

The strength of an urge was the best predictor of pulling. Feeling bored predicted pulling at the next check-in, a few hours later, and feeling tired predicted stronger urges later. Feeling low or going over worries was linked with stronger urges in the moment, but didn’t predict what happened next. The effects were small, and the group was fairly small.

Recovering without treatment

Neelapu and Grant compared 21 adults who had recovered from trich or skin picking without formal treatment with 41 people who still had it. Those who recovered had fewer other conditions now, especially depression and ADHD (attention deficit hyperactivity disorder). How much they had once pulled was about the same as the other group.

Recovery rarely meant stopping completely. Nearly 8 in 10 of those who had recovered still pulled or picked now and then, or had swapped to a different habit. This was a small study, and people were remembering their own history.

Trich and OCD in the genes

Greenspun and colleagues studied 101 people with trich or skin picking and their parents. They looked at polygenic scores, which add up thousands of small genetic differences linked to a condition. People with trich or skin picking had inherited more of the genetic variation linked to OCD than chance would predict. There was no such pattern for depression, anxiety or ADHD.

Some people also had rare missing or extra stretches of DNA in genes involved in how brain cells connect. Almost everyone in the study was female and of European ancestry, so the results may not apply to everyone. There’s more on what drives pulling in our guide to what causes trichotillomania.

A higher risk of alcohol and drug problems

Farhat and colleagues used Sweden’s national health records to follow 1,136 people with a trichotillomania diagnosis and 11,360 people without one. Over about six years, 12.1% of people with trich developed alcohol- or drug-related problems, compared with 3.5% of the others. That’s about three times the risk, even after the researchers allowed for family history of substance problems.

This study shows a link, not a cause. It only included people whose trich had been diagnosed and recorded by a health service, so it may not reflect everyone who pulls.

How strong is each kind of study?

A review that combines many trials tells you more than any single study, and a trial that assigns people by chance tells you more than a handful of case reports.

What does the latest trichotillomania research mean for me?

The message this year is steady: the approaches with the most support are the ones already recommended, and the evidence behind them keeps growing.

• Habit reversal is still the core. If you’re choosing help, ask whether it includes noticing and replacing the pulling movement. Our guide to Habit Reversal Training explains the steps.
• Structured self-help is a real option. A good online programme, worked through steadily, helped many people. Building in accountability, such as a regular check-in, seems to help.
• Watch the quiet moments. Boredom and tiredness may matter more than you’d expect, so plan for idle time and tired evenings.
• It isn’t your fault. Genes play a part in trich, and some of them overlap with OCD. Pulling isn’t a lack of willpower.
• Recovery is possible, and it’s often partial. Pulling less and less, with the odd lapse, is a common and worthwhile outcome. Our guide to whether trichotillomania goes away covers the long-term outlook.
• Ask about medication or supplements with a doctor. NAC has good support in adults but mixed results in children. Our complete guide’s section on medication and supplements summarises the options. Never start or change anything without speaking to a doctor or pharmacist.

For the numbers on how common trich is, who it affects and when it starts, see our trichotillomania statistics.

When should I get help?

Get support if pulling is upsetting you, taking up a lot of your time, or affecting your work, school or relationships. You don’t need to wait until it feels bad enough.

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 for someone who understands hair pulling near you or online.

If you’re a parent reading this for your child, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

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

Sources

1. Fisak, B., Shorb, C., Patel, D. & Ezcurra, V. (2026). The efficacy of psychotherapeutic and pharmacological interventions for trichotillomania: A review and meta-analysis. Journal of Psychiatric Research, 197, 264–274.
2. Barber, K.E., Cram, I.F., Smith, E.C., Woods, D.W. & Lee, H.J. (2026). Effectiveness of digitally-delivered interventions for trichotillomania and skin picking disorder: A systematic review and meta-analysis. Journal of Psychiatric Research, 196, 244–256.
3. Sharifi, S., Estill, M., Tordjman, L., Millan, S.H. & Ouyang, J.X. (2026). Treatment strategies for pediatric trichotillomania: State-of-the-art review on progress and persistent challenges. Pediatric Dermatology, 43(1), 3–10.
4. Gallinat, C., Wilhelm, M., Moessner, M. & Bauer, S. (2026). Trichotillomania: The interplay between emotional states, urges and hair pulling episodes. Comprehensive Psychiatry, 149, 152727.
5. Neelapu, M. & Grant, J.E. (2025). Clinical characteristics of natural recovery in trichotillomania and skin picking disorder. Frontiers in Psychiatry.
6. Greenspun, S.R., Milanes, I., Farhat, L.C., et al. (2026). A genomic study of trichotillomania and excoriation disorder in families. Translational Psychiatry, 16, 432.
7. Farhat, L.C., Isomura, K., Kuja-Halkola, R., Brikell, I., Chang, Z., D’Onofrio, B.M., Larsson, H., Lichtenstein, P., Fernández de la Cruz, L., Sidorchuk, A. & Mataix-Cols, D. (2025). Trichotillomania and risk of alcohol- and drug-related problems. Biological Psychiatry Global Open Science, 5(6), 100605.