What drives the urge to pull your hair out?

If you’ve ever picked at or pulled out your hair impulsively, you’re not alone. This urge can come from a common mental health condition called trichotillomania, which is characterized by an irresistible urge to pull out your hair. Around 4% of the population lives with this condition, and women are much more likely to be diagnosed.

Trichotillomania isn’t technically a form of self-harm, which is when people hurt their own bodies on purpose (examples include cutting or biting skin). But just because you’re not intentionally trying to hurt yourself doesn’t mean that pulling out your hair doesn’t cause physical and mental harm. 

Living with these urges and the aftermath of hair pulling can cause intense feelings of shame. But with behavioral therapy techniques and mental health treatment, you can learn how to resist these urges and protect your mental well-being. 

How thoughts of self-harm lead to hair pulling

Hair pulling is considered a body-focused repetitive behavior, which isn’t the same thing as self-harm (officially defined as nonsuicidal self-injurious behavior). But these two types of behaviors can be linked, and research shows that many people who have a history of self-harm are more likely to engage in severe hair pulling.

Often, hair pulling is a key symptom of a mental health condition called trichotillomania. People with trichotillomania have an irresistible urge to pull out their hair, including head hair, body hair, and facial hair like eyelashes and eyebrows. Trichotillomania is an impulse control disorder.

People who pull their hair out due to trichotillomania aren’t usually trying to hurt themselves. But hair pulling can cause other problems, like damage to your skin, changes to your appearance, or relationship conflicts or stress. 

Hair pulling is most often considered a body-focused repetitive behavior and is more likely to happen without reflective awareness. In other words, you might be pulling your hair out before you realize you’re doing it. People with trichotillomania are also more likely to engage in these behaviors because they’re bored or to fix their appearance. For example, you might see a hair that looks “out of place” and have the urge to pull it out.

Some people may pull their hair as a form of self-harm, not because of trichotillomania or impulse control issues. It’s important to reflect on your motivations for hair pulling, because self-harming behaviors and body-focused repetitive behaviors are approached differently. Ask yourself: Are you pulling your hair in response to an intense emotion or to hurt yourself (self-harm)? Or is hurting yourself an unintended consequence (trichotillomania)?

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What happens when you pull your hair out

Hair pulling can have a variety of consequences for your physical and mental health. These include: 

• Bald patches, which can affect your appearance
• Physical injury to your skin, like sores that can become infected
• A sense of embarrassment or shame about your urge to pull out your hair
• Avoidance of others due to embarrassment or alterations to your physical appearance 

If you’re pulling your hair out as a form of self-harm, this can cause further consequences to your mental health. Research shows that people who self-harm are at much higher risk of experiencing suicidal thoughts and attempts.* 

*A note on safety: If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. 

Coping with the urge to pull your hair out

Some people find they’re able to stop pulling their hair out on their own. Many children who develop trichotillomania symptoms before age 6 recover naturally without treatment over time. For adults, trichotillomania may go away naturally within 12 months. 

To cope with hair-pulling urges on your own, try these tips based on habit reversal training (HRT), a behavioral therapy technique that’s been found to be effective for trichotillomania.

Become aware of early warning signs

It can be helpful to notice the signs that you’re about to pull your hair out. For example, you might notice when your hand moves to your head. Or you might notice even earlier warning signs, like looking at yourself in the mirror or experiencing an itch on your eyebrows. If you can train yourself to notice these signs, you may be able to catch yourself before you actually engage in pulling out your hair.

Manage triggers

If you know that certain situations or places trigger you to pull out your hair, find ways to manage them. For example, many people with trichotillomania are more triggered when they’re alone and bored. Others may begin hair pulling when they are around certain people or places. Try to notice when you’re in these scenarios and prepare for them. For example, you might listen to a podcast when you’re alone so you’re distracted from these urges. 

Find a replacement behavior

One of the key parts of habit reversal training is replacing the unwanted behavior (in this case, hair pulling) with another, healthier behavior. Try to think of something that physically keeps you from pulling your hair. For example, you might sit on top of your hands or play with a fidget toy. You can’t pull on your hair if your hands are otherwise occupied.

Practice relaxation

Lastly, find healthy ways to manage your stress and relax your nervous system. Stress can be a trigger for any impulsive behavior, including hair pulling. You might also experience a surge of stress when you first start resisting the impulse to pull your hair. So it’s important to find ways to relax. Try using evidence-based strategies, like deep-breathing techniques or progressive muscle relaxation.

Treatment for trichotillomania and self-harm

If your urges to pull out your hair don’t go away or worsen, or if you’re pulling your hair as a way to intentionally hurt yourself, you could benefit from professional mental health treatment. 

A therapist can guide you through habit reversal training and help you find successful replacement habits. They may also recommend other treatment methods, including:

• Cognitive behavioral therapy (CBT): CBT can help you examine and reframe unhelpful thinking patterns that may be contributing to your hair-pulling behaviors.
• Dialectical behavior therapy (DBT): DBT teaches you alternative, healthier ways of coping with emotional distress so you don’t resort to hair pulling.
• Mindfulness-based therapies: Mindfulness is the practice of staying in the present moment. Mindfulness-based therapy methods can help you become more aware of what triggers you to pull your hair and be more intentional about your actions.

Find care with Rula

Pulling out your hair can cause feelings of embarrassment and shame, but you’re not alone — and you deserve support. Hair pulling is a common impulsive behavior that many people live with, and it can be successfully stopped. A therapist can help you replace hair-pulling behavior with less harmful ones. They can also help you process any feelings that might be coming up for you before, during, and after hair-pulling episodes.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 10,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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