Trichotillomania and Anxiety: The Link and What Helps

If your hair pulling gets worse when you're stressed, it's natural to wonder whether trichotillomania is really anxiety in disguise. Trichotillomania and anxiety are closely linked. Many people with trichotillomania (trich) also live with anxiety, and the two can feed each other. But they aren't the same thing, and plenty of people pull when they feel perfectly calm.

This guide explains where trich sits in the medical manuals, why stress turns up the urge to pull, why pulling also happens when you're relaxed or bored, and what helps with both. It's written for adults and teens who pull.

Is trichotillomania an anxiety disorder?

No. Trichotillomania is not classed as an anxiety disorder, although anxiety is one of the conditions that most often comes with it. 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.

The DSM-5 is the diagnostic manual published by the American Psychiatric Association and used by clinicians in many countries. Since 2013 it has listed trichotillomania in a chapter called "obsessive-compulsive and related disorders". Before that, trich was grouped with impulse-control conditions. The same update moved OCD (obsessive-compulsive disorder) out of the anxiety disorders chapter and into this new group. The World Health Organization's manual, the ICD-11, groups trich the same way.

The older ICD-10 made tension before pulling, and relief afterwards, part of the definition. The newer manuals dropped that requirement, partly because research showed that people also pull when they're bored or on autopilot, not only when they're tense.

Our guide to whether trichotillomania is a type of OCD explains how trich differs from its closest neighbour.

So trich is its own condition. What research does show is that it very often turns up alongside anxiety:

Why do I pull more when I'm stressed or anxious?

Because pulling can bring quick, short-lived relief. When you feel tense, worried or wound up, pulling turns that feeling down for a moment, and your brain learns to reach for it the next time the feeling builds.

In a study of 44 people with trichotillomania, participants rated their feelings before, during and after pulling. Anxiety, tension and boredom fell across the pulling cycle, and relief rose. Guilt, sadness and anger went up afterwards. That after-feeling matters: shame and upset can become the next trigger, which is how a stressful week can turn into a heavy pulling week.

Many people with trich say their pulling gets worse when their anxiety rises, and people who have an anxiety disorder as well as trich tend to have more severe pulling. In a 2026 study, 61 adults logged their feelings on their phones seven times a day for 10 days. Feeling tired predicted stronger urges later on, and anxious or low feelings came with stronger urges in the moment.

Stress doesn't cause trichotillomania on its own. It's one push on a condition that also involves genes and the way the brain builds habits.

Our guide to what causes trichotillomania covers the rest of the picture.

The loop of relief and regret is also described in our complete guide to trichotillomania.

Can I pull when I'm relaxed too?

Yes. Plenty of pulling happens when you feel calm, bored or absorbed in something, such as reading, scrolling, watching TV or lying in bed. For some people, this is most of their pulling.

In the 2026 phone-logging study, boredom was the feeling that predicted the next pulling episode. Anxiety and other negative feelings did not. Being in a good mood went with weaker urges in the moment. The check-ins were hours apart, so quick surges of anxiety may have been missed, but the researchers concluded that pulling isn't always about managing emotions. A 2021 study of 56 adults came to a similar view: people with trich had more difficulty managing their emotions than people without it, but that difficulty wasn't linked to how severe their pulling was.

Pulling you're aware of is often called focused pulling, and pulling on autopilot is called automatic pulling. Most people do both.

Our guide to focused vs automatic pulling explains how to work out your own mix.

What helps with both?

Behavioural therapies have the most research behind them for trichotillomania, and some also ease anxiety at the same time. If you have an anxiety disorder as well, it's worth getting that treated too.

• Habit Reversal Training (HRT). A talking therapy that teaches you to notice the earliest signs of pulling and do something else with your hands instead, such as pressing your palms on your thighs until the urge passes. This is called a competing response. A 2014 review of 11 trials found large improvements with behaviour therapy. Trials with more therapy time, or that added techniques for handling mood and feelings, showed bigger effects.
• Acceptance and commitment therapy (ACT) with HRT. ACT teaches you to make room for uncomfortable feelings and urges without acting on them. In a small trial of 25 adults, 10 sessions combining ACT with HRT reduced pulling and also reduced anxiety and low mood, compared with people still waiting for treatment.
• The ComB model (Comprehensive Behavioral model). A practitioner maps what drives your pulling, including physical sensations, thoughts, feelings, movements and places, and matches a strategy to each. An anxiety trigger and a boredom trigger get different tools.
• Treatment for the anxiety itself. For generalised anxiety disorder, the NHS (the UK's National Health Service) says the main treatments are talking therapy, usually cognitive behavioural therapy (CBT), and sometimes a type of antidepressant called an SSRI (selective serotonin reuptake inhibitor). CBT helps you change unhelpful patterns of thinking and behaviour.
• Medication and pulling. SSRIs are often prescribed to people with trich. The 2014 review found they had a moderate effect on pulling on average, smaller than behaviour therapy, and called for more trials. They aren't a reliable treatment for pulling on their own, but they can help when anxiety or depression is part of the picture. Speak to a doctor or pharmacist before starting or stopping any medicine.

Everyday habits that calm anxiety can take some pressure off pulling too. The NHS suggests slow breathing exercises, regular exercise, enough sleep and cutting down on caffeine. For bored or automatic pulling, keep something to fiddle with in the places you usually pull.

You can read more in our guide to Habit Reversal Training.

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

Our guide on how to stop pulling your hair has step-by-step strategies for getting through an urge.

When should I get help?

Get support if pulling or anxiety is upsetting you, taking up a lot of your time, or getting in the way of school, work, sleep or relationships. You don't need to wait until either one feels "bad enough".

When you see someone, tell them about both. Untreated anxiety can get in the way of trich treatment, so a joined-up plan makes sense. Many doctors and therapists have little experience of hair pulling. 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.

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

In an emergency, call 111 or go to your nearest emergency department.

• Need to Talk? (free call or text) — 1737 (1737.org.nz)
• Lifeline Aotearoa — 0800 543 354
• Youthline — 0800 376 633

Questions people ask

Sources

1. American Psychiatric Association (2013). Highlights of Changes from DSM-IV-TR to DSM-5. American Psychiatric Association.
2. Farhat, L.C., Isomura, K., Fernández de la Cruz, L., Sidorchuk, A., Kuja-Halkola, R., Brikell, I., Chang, Z., D’Onofrio, B.M., Larsson, H., Lichtenstein, P. & Mataix-Cols, D. (2025). Sociodemographic and clinical characteristics of 1,234 individuals diagnosed with trichotillomania in the Swedish National Patient Register. Scientific Reports, 15, 10396.
3. Grant, J.E., Redden, S.A., Leppink, E.W. & Chamberlain, S.R. (2017). Trichotillomania and co-occurring anxiety. Comprehensive Psychiatry, 72.
4. Lochner, C., Demetriou, S., Kidd, M., Coetzee, B. & Stein, D.J. (2021). Hair-pulling does not necessarily serve an emotion regulation function in adults with trichotillomania. Frontiers in Psychology, 12, 675468.
5. Diefenbach, G.J., Mouton-Odum, S. & Stanley, M.A. (2002). Affective correlates of trichotillomania. Behaviour Research and Therapy, 40(11), 1305–1315.
6. Gallinat, C., Wilhelm, M., Moessner, M. & Bauer, S. (2026). Trichotillomania: The interplay between emotional states, urges and hair pulling episodes. Comprehensive Psychiatry, 149, 152727.
7. McGuire, J.F., Ung, D., Selles, R.R., Rahman, O., Lewin, A.B., Murphy, T.K. & Storch, E.A. (2014). Treating trichotillomania: A meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors. Journal of Psychiatric Research, 58, 76–83.
8. Woods, D.W., Wetterneck, C.T. & Flessner, C.A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44(5), 639–656.
9. NHS. Generalised anxiety disorder (GAD).