Is Trichotillomania a Type of OCD?

If you pull your hair, someone may have told you it’s “a kind of OCD”, or you may have wondered it yourself. This guide explains how the two are related, how they differ, and why the difference matters for getting the right help.

In short, trichotillomania (trich) and obsessive-compulsive disorder (OCD) are close relatives, not the same condition. You can have one without the other, or both at once.

Is trichotillomania OCD?

No. Trichotillomania is its own condition, not a type of OCD. Doctors place the two in the same family because they share some features, but they are diagnosed separately and they tend to respond to different treatments.

Trich is a body-focused repetitive behaviour (BFRB). BFRBs are a group of conditions where people repeatedly pull, pick or bite at their own hair, skin or nails and find it very hard to stop. Skin picking and severe nail biting are other examples.

OCD works differently. The UK’s National Health Service (NHS) describes it as a condition where unwanted, unpleasant thoughts, images or urges keep coming into your mind. These are called obsessions. They cause anxiety or unease, and you feel you have to do something to ease it, such as checking a lock again and again. These actions are called compulsions.

For a full introduction to hair pulling itself, see our complete guide to trichotillomania.

Why is trichotillomania grouped with OCD?

Because they have things in common. Both involve driven, repetitive actions that follow an urge and are hard to resist. Both can bring a short-lived sense of relief. And family studies suggest trich and OCD run in the same families more often than chance would explain.

That’s why the DSM-5 moved trich, in 2013, from the “impulse control disorders” into a chapter called obsessive-compulsive and related disorders. Its neighbours there are OCD, skin-picking disorder, body dysmorphic disorder (intense worry about a flaw in your appearance) and hoarding disorder.

The experts who advised the World Health Organization on its international manual, the ICD-11, recommended the same approach: trich and skin picking together under a heading of body-focused repetitive behaviour disorders, inside the obsessive-compulsive group. They said it wasn’t a perfect fit, but it matched how most clinicians see these conditions.

Our guide to trichotillomania in the DSM-5 and ICD explains the criteria and codes.

How is trichotillomania different from OCD?

The biggest difference is what drives the behaviour. In OCD, compulsions answer a frightening or unwanted thought. Hair pulling usually doesn’t. It tends to follow an urge, a physical sensation (like a hair that feels coarse or out of place), a feeling such as stress or boredom, or nothing you notice at all. It also often brings a moment of relief or satisfaction, which OCD compulsions don’t.

	Trichotillomania	OCD
What sets it off	An urge, a sensation, a feeling such as stress or boredom, or nothing noticeable	Unwanted, distressing thoughts, images or urges (obsessions)
How it feels	Often a moment of relief or satisfaction, then regret	Eases anxiety for a while, but doesn’t feel good in itself
Happens without noticing?	Often: much pulling is automatic, on autopilot	Compulsions usually answer a specific worry
What it focuses on	Hair, often alongside skin picking or nail biting	Often shifts over time, for example from washing to checking
Who gets diagnosed	Clinics see far more women; community surveys show a much smaller gap	Men and women about equally
Therapy with most research	Habit Reversal Training and related behavioural therapies	CBT with exposure and response prevention

OCD compulsions answer a frightening thought. Hair pulling usually answers an urge or a feeling, and often brings brief relief.

Research has found other differences too. In a South African study comparing women with each condition, hair pulling tended to start younger, and the women with OCD reported more other mental health conditions.

Our guide to focused and automatic pulling explains the two ways people pull.

Can you have trichotillomania and OCD together?

Yes, and it’s fairly common. Earlier studies found OCD in anywhere from about 5% to 27% of adults with trich. In a 2020 survey of more than 10,000 US adults, 29% of those with trich said they also had OCD. More than half of that group said their hair pulling bothered them more than their OCD did.

The link runs both ways. Hair pulling and skin picking show up more often than expected in people with OCD and in their close relatives.

When someone has both, a doctor or therapist looks at why each behaviour happens:

Pulling to follow an OCD rule, for example to stop something bad happening, may count as part of the OCD rather than trich.
Removing hair to fix a flaw you believe you see in your looks may point to body dysmorphic disorder.
Pulling that follows an urge or sensation, and brings relief, points to trich.

Wanting your eyebrows to look even is common in trich too, so the question is what drives it, not what it looks like. Each diagnosis then gets its own plan.

Does OCD treatment help trichotillomania?

Not as much as you might expect. The two main OCD treatments, exposure and response prevention and SSRI medicines, have much weaker evidence for hair pulling than the behavioural therapies designed for it.

Talking therapy. For OCD, the main therapy is a type of cognitive behavioural therapy (CBT, a talking therapy that works on the links between thoughts, feelings and actions) called exposure and response prevention (ERP). You gradually face the things that trigger your worries and practise not doing the compulsion, until the anxiety settles on its own.

Trich works differently. The urge to pull usually isn’t a fear to be faced. Researchers have noted that in OCD, holding back from a compulsion eventually brings anxiety down, but in trich it may leave people more tense instead.

The therapy with the most research behind it for trich is Habit Reversal Training (HRT), a behavioural therapy. You learn to notice when and where you pull. You use a “competing response” when an urge comes, an action you can’t do while pulling, like pressing your palms flat on your thighs. And you change your surroundings so pulling is harder. A 2026 review of about 30 trials found that therapies including habit reversal worked better than those without it.

Our guide to Habit Reversal Training explains the steps.

There is some overlap with OCD therapy. Some therapists combine habit reversal with acceptance and commitment therapy (ACT), which teaches you to notice an urge and let it pass without acting on it. The 2026 review found strong support for this combination.

Medication. SSRIs (selective serotonin reuptake inhibitors) are antidepressant medicines and a main medication treatment for OCD. For hair pulling, the results have been disappointing: a 2007 review of four trials found SSRIs did no better than a placebo. Clomipramine, an older antidepressant also used for OCD, helped in two small trials. The 2026 review found the strongest medication support for N-acetylcysteine (NAC), a supplement.

SSRIs can still be useful if you also have OCD, depression or anxiety. Talk to a doctor or pharmacist before starting, stopping or changing any medicine or supplement.

If you have both. You’ll usually need both kinds of help: OCD-focused work for the obsessions and compulsions, and habit-reversal-based work for the pulling. Experts who study these conditions say each needs its own assessment and treatment approach.

Related conditions, different toolkits. Therapy for trich centres on habit reversal rather than the standard OCD approach.

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

When should I get help?

Get support if pulling is causing you distress, taking up your time, or affecting your work, relationships or confidence, or if you think you may have OCD as well. You don’t need to wait until it feels “bad enough”.

When you speak to a practitioner, tell them about everything: the pulling, any rituals around it, and any unwanted thoughts or checking. Some therapists who treat OCD have little experience with hair pulling, so it’s fine to ask how they would work on the pulling itself.

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.

Questions people ask

Is trichotillomania an anxiety disorder?

No. Trich is a body-focused repetitive behaviour in the obsessive-compulsive and related disorders group. Anxiety often comes with it: in a large 2020 US survey, it was the most common condition people with trich also had. But many people pull when they’re calm, bored or absorbed in something, not only when they feel anxious.

Is skin picking a type of OCD too?

No. Skin-picking disorder is another body-focused repetitive behaviour, in the same DSM-5 chapter as trich. The two often happen together, feel similar to the person doing them, and are both treated mainly with habit reversal. Like trich, skin picking is related to OCD but diagnosed separately.

Was trichotillomania always grouped with OCD?

No. The American diagnostic manual first listed trich in 1987 as an impulse control disorder, a group that also included conditions like kleptomania. It moved to the obsessive-compulsive and related disorders chapter in the DSM-5 in 2013. The older international manual, ICD-10, lists it as a habit and impulse disorder, code F63.3.

Do SSRIs stop hair pulling?

On average, not for the pulling itself. A 2007 review of four trials found SSRIs worked no better than a placebo for trich. They can help with depression, anxiety or OCD that comes alongside it, which matters in its own right. Never stop or change a medicine without talking to your doctor first.

Should I see an OCD therapist for hair pulling?

You can, as long as they also understand hair pulling. Some therapists who treat OCD work with trich too, but OCD training alone doesn’t mean they do. Ask how they would work on the pulling itself, and whether they have helped other people who pull.