How to Help and Support Someone With Trichotillomania

If someone you care about pulls out their hair, you probably want to help and aren’t sure how. Maybe your partner has just told you, or you’ve noticed a friend’s thinning brows.

This guide is for partners, friends and relatives of adults and teenagers who pull. It covers how to help someone with trichotillomania, what to avoid, and the question most people ask first: should you say something when you see them pull?

Parents of younger children can start with our guide to talking to your child about hair pulling.

What do I need to understand about trichotillomania?

Trichotillomania (trich) is a recognised condition, not a bad habit or a choice. 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. Doctors place it in the same family as OCD (obsessive-compulsive disorder).

• Willpower isn’t the problem. Pulling often brings relief or calm, and the brain learns to go back to it.
• Much of it happens without noticing, while reading, scrolling or lying in bed.
• It isn’t attention-seeking or self-harm. Most people pull in private and work hard to hide it.

Shame is part of the condition. In one experiment, students rated a person who revealed they had trich less favourably than one who didn’t. That helps explain why so many people keep it hidden, and why your reaction matters when they tell you. Our complete guide explains how to support someone with trich alongside everything else about the condition.

How can I help someone with trichotillomania?

Be someone they don’t have to hide from. Ask what support they want, follow their lead, and keep your attention on them rather than their hair.

• Ask, don’t assume. Try: “Is there anything that would help, or anything I should stop doing?”
• Learn about it yourself, so they don’t have to educate you.
• Keep it low-key. Talk when they bring it up, somewhere private, not in the middle of pulling.
• Make practical help easy. If they’d like them, leave a fidget toy or soft hat within reach, without comment.
• Notice effort, not hair. Praise them for trying something new, not for how their hair looks.
• Keep doing normal things together. Many people with trich avoid swimming, haircuts or photos. Offer options quietly so they stay connected.
• Be patient with setbacks. Pulling rises and falls with stress and tiredness.

The International OCD Foundation (IOCDF), a US charity for people with OCD and related conditions, gives families similar advice: learn, talk with empathy, encourage professional help, and be patient.

Our guide to fidget toys and tools explains which kinds suit which urges.

What should I avoid saying or doing?

Avoid anything that watches, shames or blames. Even kind comments can feel like criticism. In a small interview study, people with trich described being hurt by labels like “crazy” and valued family who offered encouragement instead of blame.

Also avoid inspecting their hair, pulling their hand away, or telling others without their permission.

Should I point it out when they pull?

Usually no, not unless they’ve asked you to. Being told “you’re pulling” feels like being watched, which adds shame, and shame often leads to more pulling. Many people with trich have already been told to stop for years.

The exception is when they ask for it. Habit Reversal Training (HRT) is a talking therapy that teaches people to notice pulling and do something else with their hands. It can include help from people close by: praise when the person uses their new skills and, if agreed, a gentle reminder. This works when the person who pulls chooses it and sets the terms.

If they would like reminders, agree three things together:

1. A private signal, such as a code word or handing them a fidget.
2. When it applies, perhaps only at home, not at dinner with friends.
3. How to pause it, at any time, no questions asked.

Then use the signal once and let it go. You’re offering a moment of noticing, not making them stop.

Our guide to Habit Reversal Training explains how the therapy works.

How do I support a partner with trichotillomania?

Talk about it once, kindly, at a calm moment, then let them lead. Partners see the most, so it’s easy to slip into watching. Aim to be the one place where their hair isn’t being checked.

• Ask what’s hard, such as bright bathroom lights, swimming or holidays, and what would make it easier.
• Ask about touch. Some people love having their head stroked; for others it sets off urges.
• Keep your reactions steady when you see a bald patch or missing lashes.
• It’s fine to say no to pulling your hair. In one large survey, more than a third of people with trich had pulled hair from someone else, most often a partner. You can decline kindly and offer a fidget instead.

If someone you’re dating has just told you, thank them for trusting you. In the same survey, about 1 in 5 hadn’t told their partner at all.

If you’re the one who pulls, our guide to telling someone you have trichotillomania may help.

What if they don’t want help?

Respect it. Adults decide for themselves whether to look for treatment, and pushing usually adds shame. Say once that you’d support them if they ever want to, then leave the door open.

Look after yourself too. It’s normal to feel worried or helpless at times. Talk to someone you trust without sharing their private details. The IOCDF encourages family members to look after their own wellbeing as well.

When should they get professional help?

Suggest it gently if pulling is causing distress, taking up a lot of time, or affecting work, study or relationships. They don’t need to wait until it’s “bad enough”.

Many doctors and therapists have never worked with someone who pulls, and a poor first experience can put people off. If they’d like, you could look together. 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 someone who understands trich explains what to ask on a first call.

If the person you’re supporting is your child, The Parent’s Guide to Trichotillomania is about understanding what your child is going through.

If they seem very low or hopeless, or talk about not wanting to be here, don’t wait. Encourage them to talk to someone today, and stay with them if you can.

In an emergency, call 112 or 999 or go to your nearest emergency department.

• Samaritans — 116 123 (www.samaritans.org/samaritans-ireland)
• Pieta — 1800 247 247 (text HELP to 51444) (www.pieta.ie)
• Text About It — text HELLO to 50808

Questions people ask

Sources

1. Falkenstein, M.J. & Haaga, D.A.F. (2016). Symptom accommodation, trichotillomania-by-proxy, and interpersonal functioning in trichotillomania (hair-pulling disorder). Comprehensive Psychiatry, 65, 88–97.
2. Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J., Walther, M.R. & the Trichotillomania Learning Center-Scientific Advisory Board (2006). The Trichotillomania Impact Project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry, 67(12), 1877–1888.
3. Marcks, B.A., Woods, D.W. & Ridosko, J.L. (2005). The effects of trichotillomania disclosure on peer perceptions and social acceptability. Body Image, 2(3), 299–306.
4. Banafshi, Z. & Khatony, A. (2025). Exploring the lived experiences of individuals with trichotillomania: a descriptive phenomenological study. BMC Psychology, 13, 1040.
5. International OCD Foundation. Body-Focused Repetitive Behaviors (BFRBs).
6. Cleveland Clinic (2024). Habit Reversal Training: What It Is & How It Works.