The Talbot Centre

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Trichotillomania (Hair pulling)

What is Trichotillomania?

Trichotillomania (Trich or TTM) is a condition that involves pulling out your own hair leading to noticeable hair loss. This pulling can occur from any site where hair grows including:

  • Scalp
  • Eyelashes
  • Eyebrows
  • Arms
  • Pubic area

Many people also engage in post pulling rituals such as:

  • Examining hair
  • Rubbing hair between fingers or across lips
  • Eating, chewing or swallowing hair

Most people who pull experience significant distress and shame about their pulling, resulting in them hiding their pulling or resultant hair loss and being reluctant to speak to family or friends about their struggles.

What is Trichotillomania

Trichotillomania is one of a group of conditions known as Body Focused Repetitive Behaviours or BFRBs. BFRBs are repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping your hair, skin, lips, cheeks, or nails leading to damage to the body. Most of the information on this page applies to hair pulling and other forms of BFRBs.

quotation mark

The greatest IMPACT on a person  who pulls or picks
is not the effect it has on their hair or body but on their SELF-ESTEEM

Dr Amy Talbot, clinical psychologist and director of The Talbot Centre​

What causes Trichotillomania and other BFRBs?

At this stage the exact cause of hair pulling and other body focused repetitive behaviours is unknown. It can be triggered by simple sensory experiences such as getting sand in your hair at the beach, or by stressful life events. Hair pulling can be a way that people soothe themselves when experiencing a range of different emotions, just like a younger child might hug a favourite toy or blanket or suck their thumb (a behaviour often associated with hair pulling in very young children). Hair pulling usually starts around 11 years of age but can also occur in very young children (often referred to as Baby Trich).

There are two types of pulling behaviours:

AUTOMATIC: this kind of pulling occurs without awareness and often occurs during sedentary activities such as watching television or using the computer

FOCUSSED: this type of pulling occurs in response to specific uncomfortable physical sensations such as itchiness or pain and usually results in a feeling of relief after pulling

One of the most important things for parents to know is that

No one is to blame – not you or your child

You have not failed as a parent or caused your child to develop this behaviour. You are a key resource in helping your child to recover from hair pulling.

Try to remember that no one is to blame for the pulling or body focused behaviour. Getting angry and frustrated or punishing your child for their pulling behaviour will not help to reduce their pulling and will just result in both you and your child becoming stressed and upset.

How can therapy help?

Therapy can assist you and or your child in a number of ways, including:
  • teaching strategies to reduce hair pulling behaviour
  • educating you or your child, family, peers and school about trichotillomania
  • making environmental adjustments to reduce pulling behaviour
  • assisting you or your child to understand that you/they are not crazy or weird
  • improving self esteem
  • managing co-occurring conditions such as anxiety and depression
Therapy can also assist parents to:
  • understand more about hair pulling
  • understand helpful and unhelpful responses to hair pulling
  • provide helpful support to their child
  • remain focused on developing a relationship with your child that is not solely focused on hair and hair pulling
  • address concerns and fears about the long term impact of hair pulling on your child

What does therapy involve?

Habit Reversal Therapy

The aim of habit reversal therapy is to increase awareness of the triggers for and occurrence of unwanted behaviours such as hair pulling and to reduce the likelihood of these behaviours occurring by teaching alternative behavioural responses that can be implemented when an urge to pull is experienced.

Stimulus Control

This involves altering the environment in which pulling behaviours occur to make pulling more difficult and this less likely to occur. A problem solving approach is taken that assists individuals and families to identify particular environmental cues that may be associated with the pulling and to develop strategies that reduce the impact of these factors.

Support and Rewards

For children, parental support (and sometimes teacher support) is important in helping the child to be consistent in applying the new strategies that they have learnt. The support person might assist the child to notice when hair pulling occurs and gently remind them to implement the agreed upon response. The support person may also provide praise and/or other rewards to increase the child’s motivation to use the substitute behaviour(s).

Narrative Therapy

Strategies from narrative therapy are helpful in assisting young children to develop an understanding of their pulling as separate from themselves and in identifying strengths and supports that can be used to assist in beating the pulling behaviour. These strategies can also be helpful in assisting your child to speak about topics that are uncomfortable or bring up feelings of shame. Narrative therapy can also be useful for adults in supporting you to understand your pulling from a different perspective, reducing feelings of shame.

Cognitive Behavioural Therapy

This skills based therapy is effective in developing skills to manage unhelpful thoughts and feelings that may trigger pulling behaviour. It is also effective in addressing any co-occurring psychological issues that may be causing additional suffering for you or your child e.g., social anxiety or depressed mood.

A psychologist experienced at working with individuals and families impacted by hair pulling can work together with you to develop an appropriate treatment plan and provide ongoing support as you implement the treatment plan together.

News article

Trichotillomania: The disorder where sufferers obsessively pull their hair

SINCE she was 13, Kelly had been unable to stop pulling out her own hair. And she’s not alone.


How do I make an appointment or access more information about Trichotillomania?

If you would like to discuss how our psychologists might be able to support you or your child in managing your pulling or other BFRBs please get in touch and speak with one of our client care team members.

The Talbot Centre is a contemporary health service focussed on providing integrated health care programs. Our therapists work in collaboration with other professionals as part of a multidisciplinary team providing patient-centred care.

You can also get more information about trichotillomania from the Trichotillomania Learning Centre.