Trichotillomania Symptoms: The Signs of Hair-Pulling Disorder

Maybe you’ve spotted a thin patch you can’t explain, noticed your child’s eyelashes disappearing, or found a small pile of hairs on the sofa. Maybe you’ve pulled for years and only just learned it has a name. This guide explains trichotillomania symptoms in plain words, for adults who pull and for parents who are worried about a child.

Trichotillomania (trich), also called hair-pulling disorder, 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 own hair, skin or nails. It isn’t a bad habit, attention-seeking, self-harm or a lack of willpower. Here are the signs of trichotillomania, from the hair loss itself to what happens before and after pulling.

What are the main symptoms of trichotillomania?

The main symptoms of trichotillomania are pulling out your own hair again and again, trying to cut down or stop without success, and feeling upset or held back by it. Hair loss follows, though it isn’t always easy to see.

Doctors diagnose trich using the DSM-5, the American handbook of mental health conditions used in many countries. In plain words, it looks for five things:

1. You pull out your hair repeatedly, and it leads to hair loss. The loss can be a clear patch or thinning spread across an area.
2. You’ve tried more than once to pull less or stop.
3. It causes real distress, such as shame or embarrassment, or gets in the way of work, school, relationships or social life.
4. Another medical problem doesn’t explain it, such as a skin condition or a scalp infection.
5. Another mental health condition doesn’t explain it better. For example, removing hair only to fix a flaw you see in your appearance points to a different diagnosis.

The DSM-5 places trich in a group called “obsessive-compulsive and related disorders”, next to OCD (obsessive-compulsive disorder), though the two are separate conditions. In the ICD, the international list of diseases, its codes are F63.3 (ICD-10) and 6B25.0 (ICD-11).

If you’re wondering whether this describes you, our quick self-check goes through the signs one at a time.

What happens before and after pulling?

Many people feel a building urge before they pull, relief while they pull, and shame afterwards. Not everyone feels all three, and plenty of pulling happens on autopilot.

Before pulling, people often describe:

• A rising urge, like the pressure before a sneeze
• An itch, tingle or “not right” feeling at one spot on the scalp or brow
• A hair that feels coarse, kinked or out of place, found by running their fingers through their hair
• Stress, frustration or tiredness, or the opposite: boredom

While pulling, many feel relief, a small rush of satisfaction, or a calm, absorbed focus.

After pulling, the relief usually fades fast, and shame, frustration or worry about how their hair looks can follow.

In a large online survey of adults who pull, about 8 in 10 said they felt a building urge or tension before pulling most or all of the time, and about three-quarters said they felt relief, pleasure or satisfaction afterwards just as often. Nearly all said pulling episodes left them feeling more anxious. That mix is why trich can work like a loop: the low feeling after one episode becomes the trigger for the next.

Older diagnostic rules required tension before pulling and relief after it. For the DSM-5, a study across four research sites found that most adults with trich had these feelings, but not all, so the requirement was dropped. If you pull and can’t stop but don’t notice a big urge first, it can still be trich.

Researchers also describe two styles. Automatic pulling happens without you noticing, often while reading, scrolling, watching TV or lying in bed. Focused pulling happens with full attention, often at a mirror. Most people do both. Our guide to focused and automatic pulling explains why the difference matters.

What does trich hair loss look like?

Trich hair loss usually looks like thin or patchy areas with uneven edges, where the remaining hairs are broken at different lengths and feel stubbly. Sparse or missing eyebrows and eyelashes are also common. The loss can be large or so light that nobody else would notice.

A few patterns are typical:

• One side more than the other. The NHS notes that bald patches may be an unusual shape and affect one side of the head more.
• Loss on top with hair kept around it. Some people lose hair on the crown while the sides and back stay full. Doctors sometimes call this the “Friar Tuck” sign.
• Skin that mostly looks healthy. There may be some redness or scratches. A rash can point to a different cause, which a doctor will check for.

Body hair counts too. In the same survey, about half the adults had pulled from the pubic area in the previous two weeks.

A dermatologist (a doctor who treats skin and hair) may look at the scalp through a handheld magnifier, a check called trichoscopy. In a study of 44 people with trich, every one had hairs snapped off at irregular lengths, and more than half showed a feature called the V-sign. Clues like these help doctors tell trich apart from alopecia areata, an immune condition that also causes patchy hair loss. There’s more on this in our guide to trichotillomania vs alopecia.

Hair usually grows back once pulling stops, as long as the follicle (the small pocket in the skin that a hair grows from) hasn’t been scarred by years of pulling. Our guide to whether hair grows back after trichotillomania covers regrowth for the scalp, brows and lashes.

Which signs are easy to miss?

Some of the clearest signs of trich aren’t on the head at all. Because most people hide their pulling, the hiding and avoiding are often what shows.

• Covering up. Hats, headscarves, careful partings, drawn-on brows, false lashes or hairpieces. In the large survey, about 1 in 4 people spent between 15 minutes and an hour a day covering the effects of pulling.
• Avoiding things. Swimming, windy days, hairdressers, dating or photos. In the same survey, 4 in 10 had avoided social events because of pulling.
• Hair where you’ve been. Small clusters of hairs on a pillow, a desk or in your lap, sometimes after long, trance-like sessions.
• Rituals with the hair. Studying the root, rolling hair between the fingers, or biting and chewing it.
• Wear and tear. A sore scalp, an aching hand or wrist, and, in people who chew hair, damage to teeth.
• Other body-focused behaviours, such as skin picking or nail biting.

Some people swallow the hair they pull, which is called trichophagia. Swallowed hair can build up into a hairball in the stomach, so it needs a doctor’s check (see the safety box below). Our guide to eating hair explains the warning signs in full.

How are trichotillomania symptoms different in children?

In toddlers and preschool children, hair pulling is often self-soothing and often fades on its own. In older children and teenagers, it’s more likely to be trich that lasts, so it’s worth getting support early.

Parents often first notice hairs on the pillow, a patch on one side, missing lashes, or a child who keeps a hat on and avoids haircuts or swimming. Children often don’t realise they’re pulling, or feel too embarrassed to say. One review noted that diagnosis in young people can be held up because the child or family doesn’t know about the pulling, or doesn’t want to admit to it.

If you think your child is pulling, stay calm and curious. Scolding or pointing it out each time adds shame, and shame feeds pulling. Our guide for parents covers what to know about trichotillomania in children. If your child is a toddler, our guide to toddlers pulling hair explains what’s typical at that age.

When should I see a doctor?

See a doctor if you or your child keep pulling out hair and can’t stop, if it’s causing distress, or if there’s hair loss you can’t explain. You don’t need to wait until it’s “bad enough”.

Your GP is a good first stop, for you or your child. They can check the area, rule out other causes and refer you on if needed.

A doctor will usually look at the areas of hair loss, ask about pulling, and check that nothing else, such as a skin infection, is causing it. Extra tests are rarely needed, though occasionally a doctor takes a tiny skin sample (a biopsy). If you might have swallowed hair, they may arrange a scan or blood tests.

Try to mention the pulling itself. In the large survey, more than a quarter of people who’d had treatment felt their provider knew nothing about trich, so you can ask to be referred to someone who does. Our guide to talking to your doctor about hair pulling has words you can use.

What helps once you know it’s trich?

Trich responds to the right support. Habit Reversal Training (HRT), a talking therapy that teaches you to notice when you’re about to pull and to do something else with your hands instead, has the most research behind it.

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 to find someone who understands hair pulling. Our guide to finding a practitioner who understands trich explains what to ask on a first call. For the bigger picture, including causes and every main treatment, read our complete guide to trichotillomania.

If you’re a parent, 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

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3. Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J., Walther, M.R. et al. (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry, 67(12), 1877–1888.
4. Rakowska, A., Slowinska, M., Olszewska, M. & Rudnicka, L. (2014). New trichoscopy findings in trichotillomania: Flame hairs, V-sign, hook hairs, hair powder, tulip hairs. Acta Dermato-Venereologica, 94(3), 303–306.
5. Walsh, K.H. & McDougle, C.J. (2001). Trichotillomania: Presentation, etiology, diagnosis and therapy. American Journal of Clinical Dermatology, 2, 327–333.
6. Recabar, S. & Oakley, A. (2016). Trichotillomania. DermNet.
7. NHS. Trichotillomania (hair pulling disorder).
8. Cleveland Clinic (2026). Trichotillomania.