Trichotillomania (Hair Pulling Disorder)

~ Understanding Hair Pulling Disorder

Trichotillomania is a chronic disorder involving compulsive hair pulling that results in noticeable hair loss. It is classified as an OCD-related disorder (Body-Focused Repetitive Behavior, or BFRB) and affects people of all ages. Hair may be pulled from the scalp, eyebrows, eyelashes, beard, or other areas of the body. People with Trichotillomania often describe a building tension or urge before pulling, followed by temporary relief or gratification.

~ What Does Trichotillomania Feel Like?

Many people with trichotillomania describe two distinct pulling experiences. Focused pulling happens consciously — the person is aware of the urge, seeks it out, and experiences a deliberate sense of relief. Automatic pulling happens without conscious awareness — the person may be watching TV, reading, or working and suddenly realize they have been pulling without noticing.

Both types share the same core cycle: an internal tension or urge builds, pulling provides release, and shame or regret follows — which can itself trigger more pulling. Over time, the disorder expands to affect more sites on the body and becomes harder to stop without professional support.

~ More Common Than Most People Know

Trichotillomania affects approximately 1–2% of the population — millions of people worldwide. Many sufferers struggle in isolation, feeling profound shame and concealing the disorder for years. The condition can begin in childhood or adolescence and, if untreated, can persist throughout adulthood. Children as young as 2–5 years old can develop trichotillomania, though for most this resolves on its own. The teen-onset form is more likely to be chronic without treatment.

~ Treatment Outcome

Comprehensive Cognitive Behavioral Therapy (CBT) and Habit Reversal Training (HRT) are highly effective treatments for Trichotillomania. HRT teaches awareness of pulling urges and develops competing responses that interrupt the cycle. Many patients experience significant reduction in pulling with consistent treatment.

A newer evidence-based approach, the Comprehensive Behavioral Treatment (ComB) model, goes further by identifying the specific sensory, cognitive, affective, motor, and environmental factors that drive each individual's pulling. This highly personalized approach leads to better outcomes than a one-size-fits-all protocol.

~ What to Expect in Treatment at NY NJ Center for OCD

Dr. Henry Srednicki specializes in Trichotillomania and body-focused repetitive behaviors (BFRBs). With practices in Upper Montclair, NJ and New York City, and telehealth across 42+ states via PSYPACT, expert care is accessible wherever you are.

Treatment typically includes:

• Comprehensive assessment to identify your specific pulling triggers — sensory, emotional, situational, and cognitive


• Awareness training — learning to notice pulling urges before they become automatic


• Competing response training — developing physical substitutes that satisfy the sensory need without pulling


• Environmental modifications — adjusting your environment to reduce pulling opportunities


• Acceptance-based strategies — reducing the shame and self-judgment that fuel the pulling cycle


• Relapse prevention — building skills to manage setbacks and high-risk situations

~ Frequently Asked Questions About Trichotillomania

Will my hair grow back?
In most cases, yes — provided the follicles have not been permanently damaged by long-term pulling. Many patients see significant regrowth once pulling is reduced. Dr. Srednicki can advise on what to expect based on your individual history.

Is trichotillomania an OCD condition?
Trichotillomania is classified as an OCD-spectrum disorder (body-focused repetitive behavior). It shares features with OCD — such as the urge-relief cycle — but it is treated differently from classic OCD. Habit Reversal Training and ComB are more effective than standard ERP for trichotillomania.

Can children be treated for trichotillomania?
Yes. Dr. Srednicki has experience working with children and adolescents with trichotillomania. Treatment for younger patients is adapted to be age-appropriate and may involve parent coaching alongside the child's direct therapy.