Trichotillomania: Hair Pulling, Treatment and Regrowth

Trichotillomania, also called hair-pulling disorder, is a condition in which you repeatedly feel the urge to pull out your own hair and struggle to resist it.^[1] It affects about 1 in 100 people, and the treatment with the strongest evidence is a behavioural method called habit reversal training.^[2][3]

The hair loss is non-scarring, so hair can grow back once the pulling stops.^[4][5] The harder part is the stopping.

Signs, Causes and Who Gets Trichotillomania

Where People Pull: Scalp, Eyebrows, Eyelashes and Beard

In a survey of 133 young people, the scalp was the most common pulling site, followed by the eyelashes and eyebrows.^[7] Any body hair can be involved:^[4]

• Scalp: odd-shaped patches with short hairs,^[4] broken at different lengths^[8]
• Eyelashes: loss usually limited to the longer lashes of the upper lid^[9]
• Eyebrows: irregular gaps with hairs of uneven length^[9]
• Pubic hair: pulled more often when pulling began between 6 and 18^[10]
• Face and body: both among the sites in a survey of 123 hair pullers^[11]

Focused vs Automatic Pulling

Automatic pulling happens mostly outside your awareness. Focused pulling has a compulsive quality: you pull in response to a negative feeling such as anxiety, an intense thought or urge, or a wish for symmetry.^[12]

The difference shows up in treatment. In a trial of 40 young people, habit reversal training improved focused pulling (effect size 0.73) but barely changed automatic pulling (0.10).^[13]

Why Does Pulling Feel Good?

Most young people in one survey felt tension before pulling and relief straight after.^[7] Reviews describe the same instant release of tension.^[15]

Brain research is early. A meta-analysis of 15 studies found weaker motor inhibition, the ability to stop an action already under way, than in controls.^[16] A 2026 study found lower blood levels of the body's own opioids in 45 adults with trichotillomania, lowest in focused pullers.^[17]

Is Trichotillomania OCD?

It belongs to the same family. The DSM-5 manual groups trichotillomania with obsessive-compulsive and related disorders,^[4][18] and it is also a body-focused repetitive behaviour, like skin picking.^[19]

OCD itself turns up in a minority. Across 119 studies of hair pulling and skin picking, 13.8% had had OCD, against 35.9% for any anxiety disorder.^[20] In 50 adults with trichotillomania, nobody had OCD, yet 14.6% screened positive for probable autism.^[21] In another survey, 12% to 32% of people who pulled hair, picked skin or both reported ADHD.^[19]

What Causes Trichotillomania? Genes and Stress

Genes play a part. Identical twins shared the diagnosis in 38.1% of pairs and non-identical twins in none,^[22] yet a 2024 review of 109 studies found no high-confidence risk gene.^[23] In children, triggers included family and school problems, appearance worries and illness.^[24][25]

When Does It Start? Children and Adults

It usually begins young: the mean age at onset was 11 in one survey,^[11] and a review describes peaks in the preschool years and early adolescence.^[26]

Children. In 33 children seen at one hospital, the peak age was 3 to 4, and only 51.5% of parents had noticed the pulling; hair on or under the bed was the usual clue.^[24] Punishment does not help, and family support matters.^[4]

Women and men. Reviews describe mostly female patients,^[4] yet a meta-analysis of population studies found no clear female excess in trichotillomania itself.^[2] Boys tend to reach doctors younger than girls.^[27]

Diagnosis and Treatment of Trichotillomania

Trichotillomania vs Alopecia Areata and Other Patchy Hair Loss

The typical picture is odd-shaped patches with short hairs and a negative hair pull test.^[4][24] A dermatoscope, a lens that magnifies the scalp, adds detail: its most specific signs include split ends in 57.5% of patients and flame hairs in 37.1%.^[28]

A biopsy is sometimes needed, for instance when the diagnosis is hard to accept.^[4] Our alopecia areata entry explains the autoimmune patches in detail. For loss caused by hairstyles, read our traction alopecia entry.

Habit Reversal Training and Other Therapy

Habit reversal training (HRT) is a five-part behavioural method that builds awareness of pulling and teaches a competing response.^[32][33] Across 24 trials with 857 people, behavioural therapy with HRT had the largest effects and strongest evidence of any treatment.^[3]

A 2026 network meta-analysis found therapies with habit reversal beat those without it; HRT combined with acceptance and commitment therapy also had strong support.^[34] In children, behavioural treatment, mainly HRT, gave the greatest benefit.^[35]

Medication: N-Acetylcysteine and Other Drugs

No medicine is FDA-approved for trichotillomania.^[37] N-acetylcysteine (NAC), an amino acid that acts on the brain's glutamate system, has the best support among drugs.^[38][34]

In 50 adults taking 1,200 to 2,400 mg a day for 12 weeks, 56% were much or very much improved, against 16% on placebo.^[38] In 39 children and teenagers, NAC did no better than placebo (25% against 21%).^[39]

Other medicines rest on small trials:

• Memantine: 60.5% much or very much improved against 8.3% after 8 weeks, in 100 adults who pulled hair or picked skin^[40]
• Olanzapine: 85% responded against 17%, in one trial of 25 adults^[41]
• Clomipramine: 40% against 0% in 16 adults, with more dropouts from side effects^[41]

Relapse and the Long-Term Outlook

Relapse in adults appears to be fairly common.^[1] In children followed for about 2.8 years, few improved much without effective behavioural treatment, and older age and more focused pulling predicted a poorer course.^[42]

Will Hair Grow Back After Trichotillomania?

Usually, yes. Trichotillomania is a non-scarring hair loss,^[4][43] and in non-scarring hair loss the follicles are kept, so growth can resume once the cause is removed.^[5]

In a series of 36 patients, mostly children, pulling of under 6 months was easily corrected and the hair usually regrew within 1 to 3 months; longer cases needed psychiatric treatment.^[25]

How Long Does Hair Take to Grow Back?

Each area runs on its own hair cycle, and the growth phaseGlossaryAnagen is the growing phase of the hair cycle. For scalp hair it lasts 2 to 6 years according to a Deutsches Ärzteblatt review, and 2 to 7 years according to Cleveland Clinic.
Open in the glossary → sets how long a hair can grow.^[9]

Sources differ on the full eyelash cycle: 90 days in one measured study,^[44] 4 to 11 months in a later review.^[9] Our guide to how fast hair grows covers the scalp, and since we found no minoxidil trial after pulling, the data in our minoxidil entry come from other hair loss.

Can Trichotillomania Cause Permanent Hair Loss?

In some people it may, though nobody knows how often. Severe pulling can cause skin ulcers and scarring.^[46] A 2026 report described a boy whose pulling patches were later followed by a scarring hair loss; the authors suggest the pulling may have contributed.^[47]

If a patch has stayed bare for years, a dermatoscope can show whether the follicle openings remain.^[47] Our page on whether eyebrows grow back covers signs of lasting brow loss.

Trichophagia and Hairballs

Of 68 adults with trichotillomania, 20.6% regularly ate the hair they pulled; they were more often men and pulled more severely.^[48] Swallowed hair can form a hairball, a trichobezoar, that may block the gut and needs surgery.^[15]

A child who pulls hair and has unexplained anaemia or tummy pain should be checked for one.^[49]

Hair Transplant and Trichotillomania

A transplant is not a treatment for trichotillomania. It moves follicles from the donor areaGlossaryThe donor area is the back and sides of the head, where follicles resist DHT. An extracted follicle does not grow back in that spot, so extractions are spread out, and the donor supply is the limit of every plan.
Open in the glossary →, and surgeons list trichotillomania among the reasons a person may not be a suitable candidate.^[50] What the surgical reviews say:

• Scalp: not an absolute bar, but surgery should wait until psychological treatment has stabilised the pulling^[50]
• Active pulling: one review treats ongoing trichotillomania as a contraindication^[18]
• Eyebrows: pulling is a common reason for brow restoration, planned only once there are no active signs^[51]
• Quiet phase: FUE can help advanced brow loss if the hair loss is inactive^[52]

We found no published series of scalp transplants in trichotillomania. The closest case, from 2026, restored over-plucked brows in a man whose plucking had stopped before surgery was planned, and its authors urge screening for compulsive pulling because transplanted hairs can be pulled out again.^[53]

In brow restoration, half or more of the grafts start growing at 3 to 4 months, and full regrowth takes 6 to 8 months.^[51] Our eyebrow transplant page covers graft numbers and recovery.

Frequently Asked Questions

Is a Hair Transplant Right for You After Trichotillomania?

If you are still pulling, or stopped only recently, a transplant is the wrong next step. Treatment for the pulling comes first, and patches that have not scarred can regrow on their own.^[50][5]

If the pulling has been under control for a long time and a patch has stayed bare, a transplant may be considered once a doctor confirms the hair loss is inactive.^[50][51]

We do not treat the pulling itself. To find out whether a patch looks recoverable or suits a transplant, send us photos for a free hair analysis, or message us on WhatsApp.