Updated June 2nd, 2026
What Is Trichotillomania?
Trichotillomania is the recurrent and hard-to-control pulling out of one’s hair. The pulling occurs most commonly from the scalp, eyebrows, and eyelids, but it may occur from other regions of the body. People with trichotillomania often describe experiencing an overwhelming urge to pull their hair. This makes the behavior very difficult to control.
The problem is relatively common — it’s thought to affect between 1% and 3% of the population.
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Many people with trichotillomania think that they should be able to stop this habit with their willpower alone. Therefore, they feel embarrassed that they have difficulty stopping the hair pulling. Hair loss from the repetitive hair pulling can also lead to social isolation and emotional distress. The good news is that there are effective treatments for this condition.
Trichotillomania Treatment Options
Psychotherapy
Research has found Habit Reversal Training (HRT), a type of cognitive-behavioral therapy (CBT), to be very effective for treating trichotillomania.
This treatment will often involve the in-the-moment recording of your hair-pulling urges and behavior as well as other information, including the date, time, location, and your thoughts and feelings before and after the hair pulling. The recording not only helps increase your awareness of your urges and the behavior, but also helps you identify your patterns, such as specific time, location, feelings, or activities associated with the hair pulling.
Why awareness matters
Everything we know from scientific research on self-directed behavior change suggests that we need to enhance our awareness of a behavior in order to decrease its frequency. This makes intuitive sense — think about, for example, what it’s like to reduce the number of times you say “uh” or “um” or “like” when talking. You can do it, but you can’t do it if you’re not paying attention and improving your awareness of the habit. Once you do, then positive change is possible. Hair pulling and BFRBs work similarly. The more awareness we can create, the more effective our efforts will be.
Another key component of the treatment involves the implementation of strategies to reduce the likelihood of pulling. Think of this as putting in “speed bumps” to make it difficult for you to engage in hair-pulling behavior. What does this look like? Therapists might ask individuals who pull hair from their head, for example, to either wear a hat or to wear band-aids on their fingers. Alternatively, they might ask you to place visual reminders (STOP!) at the specific location where the pulling typically happens.
Why behavioral barriers help
You might think, well, I’ve tried that before, and I went right back to pulling my hair later on. So what’s the point? These barriers help because they reduce the frequency of the behavior in the short term. This lessens the strength and momentum of the habit. That’s a necessary, if not sufficient, step in the process of stopping hair pulling. The weaker the habit gets, the more successful your ongoing efforts are going to be. It’s similar to trying to quit smoking — getting the cigarettes out of your home will help set the stage for success tomorrow and next week.
Lastly, the treatment will involve replacing the hair-pulling behavior with less harmful behaviors. For example, when you experience an urge to pull, you might be asked to make a fist, squeeze a stress ball, or play with a fidget toy. The goal is to make it impossible for you to engage in hair-pulling behavior when there is an urge. These are called competing responses.
Why competing responses work
Competing responses work for the same reasons that behavioral barriers work — they stanch the habit’s momentum, paving the way for more success tomorrow and the day after, and so on. They don’t guarantee future success, but they are a useful tool anyway.
When it comes to figuring out out which techniques will work best, it is important to keep in mind that everyone is different. You may need to take some time to experiment with various techniques to find the ones that work for you!
Automatic vs. focused pulling
Some people find themselves pulling hair mindlessly while engaged in other activities. Watching TV, doing work, or feeling bored can all lead some people to pulling their hair without realizing it. For others, the behavior is more intentional. Sometimes it feels necessary for reasons of aesthetics or grooming. Other times it’s a conscious decision that’s made in order to deal with stress, anxiety, or other emotions.
Fortunately, behavioral therapy for either type of hair pulling can be effective.
Medication
As of 2026, the Food and Drug Administration (FDA) has not approved any medication for the treatment of trichotillomania. Selective serotonin reuptake inhibitors (SSRIs) and a tricyclic antidepressant (TCA) called clomipramine are commonly used for trichotillomania. However, the overall results on these drugs’ efficacy are mixed. More on this below.
The supplement N-acetylcysteine (NAC) is also sometimes recommended and has been studied in a few cases of problem hair pulling.
How Effective Are the Different Treatments for Trichotillomania?
Researchers have investigated several treatments for trichotillomania, with most studies focusing on behavioral therapy, clomipramine, and SSRIs. While all three approaches have received attention from researchers, the evidence generally favors behavioral therapy (including HRT and CBT).
Habit Reversal Training has consistently shown strong results in research studies. One reason HRT may be particularly effective is that it directly targets the hair-pulling behavior itself. Rather than simply trying to reduce distress or urges, the treatment teaches practical skills that help people become more aware of their pulling patterns and respond differently when urges occur.
Medication can also be helpful for some people. Clomipramine has shown benefits in several studies, although it generally appears to be less effective than behavioral therapy. SSRIs, which are commonly prescribed for anxiety and depression, have produced mixed results in studies of trichotillomania. Some people do report improvement while taking these medications.
Overall, the evidence for SSRIs is considerably weaker than it is for HRT and CBT. Both medication and therapy can be used together, of course.
Of course, no treatment works for everyone. However, based on the current research, most experts consider Habit Reversal Training and other forms of CBT to be the first-line treatment for trichotillomania. For this reason, many people seeking treatment choose to begin with behavioral therapy before considering medication.
So What Is the Best Treatment for Trichotillomania?
Unfortunately, there is no one treatment that is 100% effective for everyone who tries it.
Medication is helpful for some people, as is the supplement NAC. However, at the present time, evidence supports behavior therapy (including HRT and CBT) as the first-line treatment for trichotillomania. These treatments typically target the behaviors directly, which can be quite effective. Many people who have tried and failed to address hair pulling through willpower find greater success with structured behavioral treatment.
We also recommend the extensive resources available on the TLC website for body-focused repetitive behaviors including trichotillomania.
with contributions from Paul Greene, Ph.D.
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