Updated March 2nd, 2025
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.
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 distress. The good news is that there are effective treatments for this condition.
Trichotillomania Treatment Options
Psychotherapy
Research has found Habit Reversal Training, a type of cognitive-behavioral therapy (CBT), to be very effective for treating trichotillomania. It is the treatment of choice for this condition.
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 behavior. The recording not only helps increase your awareness of your urges and your hair-pulling behavior, but also helps you identify any patterns, such as specific time, location, feelings, or activities associated with the behavior.
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 their head hair to wear a hat or to wear band-aids on their fingers. They might ask you to place visual reminders (STOP!) at the specific location where the pulling typically happens.
It is important to realize that everyone is different. You may need to take some time to experiment with various techniques to find the ones that work for you!
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.
Medication
As of now, 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 considered the first line of pharmacotherapy for trichotillomania (Sani et al., 2019). However, the overall results on these drugs’ efficacy are mixed. Specifically, the Sani et al. review found that SSRIs only have weak evidence of benefits in improving specific trichotillomania symptoms. The researchers described Clomipramine as less effective than CBT.
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.
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 report improvement while taking these medications. Overall, however, the evidence for SSRIs is considerably weaker than it is for HRT. Both medication and HRT can be used together, of course.
Of course, no treatment works for everyone. Some people benefit from medication, some benefit from therapy, and some use a combination of both. 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.
You can find more information on the specific strategies mentioned here. We also recommend the extensive resources available on the TLC website for body-focused repetitive behaviors.
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