Trichotillomania Glossary: Key Terms in Plain English

Reading about hair pulling means meeting a lot of unfamiliar words. Some are medical, some come from therapy, and some are the shorthand people use online. This trichotillomania glossary explains each one in plain English, so you can follow what a doctor, a therapist or an article is telling you.

Every entry starts with a one- or two-sentence definition that makes sense on its own. Where there’s more worth knowing, a little extra detail follows, and sometimes a link to a fuller guide. The terms are grouped by topic, and you can jump straight to any of them.

What do the core terms in this trichotillomania glossary mean?

These are the words for the condition itself and where it sits among other conditions. Trichotillomania is one of a family of body-focused repetitive behaviors, and doctors group it alongside OCD.

Trichotillomania

Trichotillomania is a condition in which a person repeatedly pulls out their own hair, finds it hard to stop, and loses hair as a result. It’s also called hair-pulling disorder, trich (said “trick”) or TTM.

People most often pull from the scalp, eyebrows and eyelashes, though any body hair can be involved. About 1 in 50 people have trich at some point, and it usually starts between the ages of 10 and 13, though it can begin at any age. It isn’t a bad habit, attention-seeking or self-harm, and it isn’t a lack of willpower.

Our complete guide to trichotillomania covers causes, diagnosis and treatment in depth.

Body-focused repetitive behavior (BFRB)

A body-focused repetitive behavior (BFRB) is a repeated action aimed at your own body, such as pulling, picking, biting or scraping, that causes damage and that you’ve tried and failed to stop. Trichotillomania and skin picking are the two most common BFRBs.

Other BFRBs include nail biting (onychophagia), nail picking (onychotillomania), cheek biting (morsicatio buccarum) and skin biting (dermatophagia). Many people with trich also have another BFRB.

Our guide to body-focused repetitive behaviors covers the whole group.

OCD (obsessive-compulsive disorder)

OCD is a condition in which unwanted thoughts, images or urges (obsessions) keep coming back and cause anxiety, and a person feels driven to repeat actions or mental acts (compulsions) to ease that feeling. Trichotillomania is listed in the same family of conditions as OCD, but it is a different condition.

Pulling isn’t usually a response to obsessive thoughts, and it often brings relief or a sense of satisfaction. Around 13% of people with trich also have OCD. Read more in our guide to trichotillomania and OCD.

Comorbidity

Comorbidity means having two or more conditions at the same time. With trich, the most common ones are other BFRBs, such as skin picking, and depression.

Doctors ask about other conditions so that any treatment plan can take them into account.

What words describe how pulling happens?

These terms describe the moments around pulling: what sets it off, how aware you are of it, and what happens before and after. Knowing them makes it easier to spot your own patterns.

Urge

An urge is the strong pull, or build-up of tension, that people feel before pulling. For many, the tension eases once a hair comes out, which is part of what makes pulling hard to stop.

Several therapies teach ways to let an urge pass without acting on it, such as a competing response or urge surfing.

Trigger

A trigger is anything that makes pulling more likely. It might be a place (being alone, a mirror), an activity (reading, scrolling), a feeling (stress, boredom, anxiety) or a sensation (a hair that feels coarse or out of place).

Tracking your pulling is the quickest way to find yours. Our hair-pulling tracker helps you log when and where you pull.

Focused pulling

Focused pulling is pulling you are aware of and choose to do, often to ease an urge, tension or an uncomfortable feeling. It often happens at a mirror or while searching for a particular hair.

Researchers describe focused and automatic pulling as two styles, and many people pull in both ways. Our guide to focused and automatic pulling explains why the difference matters for what helps.

Automatic pulling

Automatic pulling happens without you noticing, usually during quiet activities such as reading, studying, watching TV, scrolling or lying in bed. People sometimes only realize they’ve been pulling when they see hairs in their lap.

Because you’re not aware of it in the moment, noticing is the first step: see awareness training and stimulus control.

Rituals

Rituals are the steps many people go through around pulling. They include searching by feel for a hair that seems “right”, looking closely at the root, rolling the hair between the fingers, or running it across the lips or biting off the root.

These rituals are common, even though many people assume they’re the only one who does them. Our guide to why pulling hair feels good looks at them in more detail.

Early childhood pulling (“baby trich”)

Early childhood pulling is hair pulling in babies, toddlers and preschool children, sometimes called “baby trich”. Pulling in toddlers and very young children often stops on its own.

If it carries on, or you’re worried, it’s worth talking to your child’s doctor. Our guide to toddlers who pull their hair explains what to look out for.

Lapse and relapse

A lapse is a short slip back into pulling after a spell of pulling less. A relapse is a longer return to the old pattern.

Setbacks happen to many people and aren’t a sign of failure. The skills that helped before are worth coming back to. Our guide to handling a relapse covers what to do next.

What do the terms for related conditions and hair loss mean?

Some words describe conditions that often go with trich, and others describe conditions that can look like it. A few explain what happens to hair itself.

Skin picking disorder (dermatillomania)

Skin picking disorder is repeatedly picking at your own skin, often without realizing, so much that it causes cuts, bleeding or bruising, and finding it hard to stop. It’s also called dermatillomania or excoriation disorder.

Like trich, it’s a BFRB, and many people have both. Our guide to skin picking and hair pulling covers what helps when you have both.

Trichophagia

Trichophagia means eating or swallowing hair, including chewing or biting off the root after pulling. One review estimated that around 30% of people with trichotillomania eat hair.

Most people who eat hair never have a problem from it, but it’s worth knowing the warning signs below. Our guide to eating hair explains more.

Trichobezoar

A trichobezoar is a mass of swallowed hair that collects in the body, most often in the stomach. It is uncommon: the same review estimated that only about 1 in 100 people who eat hair develop one.

It can cause nausea, vomiting, stomach pain, feeling full quickly and weight loss, and it needs medical treatment.

Rapunzel syndrome

Rapunzel syndrome is a rare type of trichobezoar in which the hair mass in the stomach stretches like a tail into the small intestine. It’s named after the fairy-tale character with very long hair.

Large trichobezoars can block or damage the gut, and they sometimes need surgery to remove.

Alopecia

Alopecia is the medical word for hair loss, whatever the cause. On its own it doesn’t say why hair is missing; the word that comes with it names the type.

Trich is sometimes mistaken for other types of alopecia, so it helps to know the two below.

Alopecia areata

Alopecia areata is an autoimmune condition, meaning the immune system mistakenly attacks the hair follicles (the tiny pockets in the skin that hairs grow from). It causes patches of hair loss, most often on the scalp.

The patches are usually smooth, sometimes with short hairs that narrow toward the scalp. With trich, a doctor more often sees hairs broken off at different lengths. Because both cause patchy hair loss, the two can be confused. Our guide to trichotillomania and alopecia explains how doctors tell them apart.

Traction alopecia

Traction alopecia is hair loss caused by hairstyles that pull tightly on the hair over a long time, such as tight braids, cornrows, ponytails, buns, weaves or extensions. It usually starts at the hairline.

It’s different from trich because the pulling comes from the hairstyle, not from the hands. If the tension carries on for a long time, the hair loss can become permanent.

Body dysmorphic disorder (BDD)

Body dysmorphic disorder is a condition in which a person spends a lot of time worrying about flaws in their appearance that other people often can’t see.

Someone with BDD might pluck or remove hair to fix a flaw they see. When hair removal is mainly about correcting how you look, doctors consider BDD rather than, or as well as, trich.

Hair growth cycle

Each hair grows in a repeating cycle. There’s a growing phase (anagen), which on the scalp lasts about 3 to 10 years; a short transition phase (catagen) of 2 to 3 weeks; and a resting phase (telogen) of about 3 to 4 months, after which the old hair is pushed out by a new one.

Pulling removes a hair before its cycle would have ended. Our guide to whether hair grows back explains what to expect for the scalp, brows and lashes.

What terms might come up when a doctor checks for trich?

These are the manuals, codes and checks doctors use when they diagnose trichotillomania or track how it’s going. A diagnosis is usually based on a conversation and a look at the hair and scalp.

DSM-5-TR

The DSM-5-TR is the current edition of the Diagnostic and Statistical Manual of Mental Disorders, the manual the American Psychiatric Association publishes to help clinicians diagnose mental health conditions. It lists trichotillomania in the group “obsessive-compulsive and related disorders”.

In short, it describes trich as repeatedly pulling out your hair so that hair is lost, trying again and again to cut down or stop, and finding it causes distress or gets in the way of daily life. The pulling must not be better explained by another medical or mental health condition. Our guide to trichotillomania in the DSM-5 and ICD goes through the criteria.

ICD-10 and ICD-11

The ICD (International Classification of Diseases) is the World Health Organization’s list of health conditions, with a code for each. In ICD-10, trichotillomania is code F63.3; in the newer ICD-11 it is code 6B25.0.

ICD-10 grouped trich with “habit and impulse disorders”. ICD-11 moved it into a new group, body-focused repetitive behavior disorders, within obsessive-compulsive or related disorders, alongside excoriation (skin picking) disorder.

Trichoscopy

Trichoscopy is a quick check in which a doctor, usually a dermatologist (skin and hair doctor), looks closely at the hair and scalp through a magnifying device. It doesn’t hurt and needs no needles or samples.

In a study of 44 people with trich, every one had hairs broken off at different lengths. Other signs with names such as “V-sign” and “flame hairs” help doctors tell trich apart from alopecia areata.

MGH Hairpulling Scale (MGH-HPS)

The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) is a short questionnaire of seven questions that people fill in themselves. It measures how often and how strongly urges and pulling happen, how much distress they cause, and how much control a person feels they have.

Therapists and researchers use it to track change over time. It isn’t a diagnosis on its own. If you’re wondering whether this describes you, our self-check is a gentle place to start.

What do the therapy terms mean?

These are the talking therapies and techniques used for trich. Habit Reversal Training and approaches built on it have the most research behind them; the others are often added to it.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a talking therapy in which a therapist helps you change how you think and act. For most conditions, a course of CBT runs for about 5 to 15 sessions.

For trich, CBT usually includes Habit Reversal Training. Our guide to CBT for trichotillomania explains what sessions involve.

Habit Reversal Training (HRT)

Habit Reversal Training (HRT) is a behavioral therapy that teaches you to notice when you’re about to pull and to do something else with your hands instead. It was first described in 1973 and has more research behind it than any other talking therapy for trich.

Its main parts are awareness training, a competing response and social support, meaning someone you trust who encourages your efforts. Therapists often add stimulus control. Our guide to Habit Reversal Training walks through each step.

Awareness training

Awareness training is the first part of Habit Reversal Training: learning to spot pulling, and the moments just before it, as they happen.

It usually includes self-monitoring, which means keeping a simple record of when, where and how you pull.

Competing response

A competing response is an action you can’t do at the same time as pulling, such as gently clenching your fists or pressing your hands flat on your thighs. You hold it when an urge comes, until the urge eases.

It’s a key part of Habit Reversal Training. Many people choose one they can do anywhere without others noticing.

Stimulus control

Stimulus control means changing your surroundings so pulling is harder or less tempting. Examples include covering a mirror during your risky times, wearing gloves or finger covers in bed, or keeping tweezers out of reach.

It can be particularly useful for automatic pulling, because a barrier gives you a moment to notice what your hand is doing.

Decoupling

Decoupling is a self-help technique that trains you to swap the pulling movement for a different, harmless movement, practiced often enough that the swap becomes automatic. It was developed by the psychologist Steffen Moritz and colleagues.

It has been tested in a few small studies for hair pulling, nail biting and skin picking. The evidence is still limited.

Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) is a talking therapy that teaches you to make room for uncomfortable urges, thoughts and feelings without acting on them, and to focus on what matters to you.

For trich it’s often combined with Habit Reversal Training. In a small 2006 trial of 25 people, ACT plus habit reversal reduced pulling compared with a waiting list, and the gains held at a three-month check-up. Our guide to ACT and DBT for hair pulling covers both.

Urge surfing

Urge surfing is a skill from ACT: you notice an urge, watch it build and pass like a wave, and don’t act on it.

Each urge you ride out without pulling is practice for the next. It pairs well with a competing response, which keeps your hands busy while the wave passes.

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) is a talking therapy that teaches skills for handling strong emotions and getting through distress.

Researchers have added DBT skills to Habit Reversal Training for people whose pulling is closely tied to emotions. In a small study of 10 people, 9 were still responding to treatment six months later. Larger trials are needed.

ComB model

The Comprehensive Behavioral (ComB) model is an approach, first described in 1997 by psychologist Charles Mansueto and colleagues, that looks at everything that keeps a person’s pulling going and matches a strategy to each part.

It sorts those drivers into five areas, known as SCAMP, and builds a plan around the areas that matter most for you. Our guide to the ComB model explains it step by step.

SCAMP

SCAMP stands for the five areas the ComB model looks at: Sensory, Cognitive, Affective, Motor and Place. In plain words, those are sensations, thoughts, feelings, movements and places.

• Sensory: physical sensations that set off pulling or make it feel good.
• Cognitive: thoughts and beliefs that encourage pulling, such as “just one more”.
• Affective: emotions such as boredom, anxiety or frustration, and the relief pulling brings.
• Motor: habitual movements and postures, such as resting your head on your hand.
• Place: surroundings and cues, such as being alone, a mirror or tweezers nearby.

What do the medicine and research terms mean?

No single medicine has been shown to work consistently for trichotillomania, but several have been studied. Always speak to a doctor or pharmacist before starting any medicine or supplement, especially if you take other medicines.

SSRIs

SSRIs (selective serotonin reuptake inhibitors) are the most widely used type of antidepressant. They work on serotonin, a chemical messenger in the brain linked to mood.

Doctors sometimes prescribe them for trich, but trials looking at pulling itself have given mixed results. They may help more when depression or anxiety is also part of the picture. Our guide to medication for trichotillomania looks at the evidence.

N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is a supplement that acts on glutamate, another chemical messenger in the brain. It is one of the most studied options for trich.

In a 2009 trial of 50 adults, 56% of those taking NAC improved a lot, compared with 16% of those taking a placebo. A later trial in children aged 8 to 17 found no benefit over placebo. Our guide to NAC for trichotillomania goes through the studies.

Placebo

A placebo is a dummy treatment, such as a tablet with no active ingredient. Researchers compare a real treatment with a placebo to see whether it works better than simply taking something.

When you read that a treatment “beat placebo”, it means people on the real treatment improved more than people on the dummy one.

Which organizations will I see mentioned?

Two names come up often in articles, books and research about BFRBs.

IOCDF

The International OCD Foundation (IOCDF) is an organization for OCD and related conditions, including BFRBs. It now continues the work started by the TLC Foundation for BFRBs.

It publishes information, runs events and connects people with support groups. You can read the IOCDF’s own information about BFRBs.

TLC Foundation for BFRBs

The TLC Foundation for BFRBs was an organization that focused on hair pulling, skin picking and other BFRBs. It wound down at the end of 2025, and the IOCDF has taken on its work.

Older articles, books and research papers may still mention it.

When should I get help?

Get support if pulling is causing you distress, taking up a lot of your time, or affecting your work, school or relationships, or if you’ve tried to cut down on your own without much change. You don’t need to wait until it feels “bad enough”.

Many doctors and therapists have never worked with someone who pulls. 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. Our guide to finding a therapist who understands trich explains what to ask on a first call.

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 911 or go to your nearest emergency department.

• 988 Suicide & Crisis Lifeline — 988 (988lifeline.org)

Questions people ask

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