Counselling for Trichotillomania: How Therapy can support Trichotillomania

Trichotillomania, also known as trich or hair-pulling disorder, is when someone can’t resist the urge to pull out their own hair. They may pull out hair from their head or from other places on their body such as their eyebrows or eyelashes.

Trichotillomania is listed under ‘Obsessive-compulsive disorder and related disorders’ in the latest Diagnostic and Statistical Manual of Mental Disorders, it is not the same as Obsessive Compulsive Disorder.

With OCD, behaviours are preceded by an intrusive thought, compelling the person to complete the action. With trichotillomania, this is not necessarily the case – the behaviour might be the result of tension, stress, or out of habit. Trichotillomania might be better described as a type of ‘body-focused repetitive behaviour’ (such as nail-biting or skin picking).

Sufferers of trichotillomania often feel shame as they think that these behaviours are unique to them when, in fact, they are a relatively common feature of trichotillomania. The hair loss resulting from prolonged pulling can also have a huge impact in terms of feelings of embarrassment, isolation, low self-confidence and problems with intimacy and relationships.

The exact cause of trichotillomania is not known. It’s believed that the onset of the hair-pulling disorder can often be linked to a particularly stressful life event such as the death of a relative, but this is not always the case.

Some researchers think that trich may have a genetic basis, but others propose that it is a normal grooming behaviour that has developed into a stress-related or tension-reducing habit. Alternative thoughts are that it could be an attempt to increase concentration or to combat boredom.


The treatments for Trichotillomania are similar to those for OCD, with the most effective form of treatment thought to be a type of Cognitive Behavioural Therapy (CBT) known as habit reversal training. Another popular treatment option if hypnotherapy. Sufferers might also seek out counselling to discuss the stress or anxiety that leads up to the hair-pulling or the event that caused the trich to develop in the first instance.