What is Trichotillomania?
By : Katherine Pica LCSW
Do I have Trichotillomania?
For some, hair pulling is driven by a very strong urge to pull. For others, it can happens without even realizing it. Pulling may happen while reading, working on the computer, watching TV, or lying in bed. You might not notice the behavior until after it’s already happened.
It’s called trichotillomania, or Hair Pulling Disorder. It’s a body-focused repetitive behavior (BFRB) that can involve pulling hair from the scalp, eyebrows, eyelashes, pubic area or other parts of the body that hair grows. It may look to some like “just a bad habit” on the surface, it really is much more.
People with trichotillomania might pull in response to stress, boredom, or emotional discomfort—or they might do it automatically, with no clear trigger at all. Some who struggle may describe it as soothing. Others feel disconnected during the act, only to feel shame or distress afterward. Trichotillomania shows up very differently from person to person which is why individualized treatment is so important.
For some it may serve as a way to cope with stress, anxiety, boredom, or overwhelming emotions. For some they might not even be aware that they are pulling. For some they might feel like it helps them concentrate. While it might bring momentary relief, the long-term impact usually includes shame, distress, and isolation.
Who does Trichotillomania Affect?
Trichotillomania often begins around the age of 10-13. However it can affect people at any age. It is seen across all genders.
People who struggle with trichotillomania might:
Experience noticeable hair loss or bald patches
Cover hair loss with hats, makeup, or hairstyles
Avoid social events or photos
Feel ashamed or secretive about the behavior
Try to stop, but feel unable to do so
Experience strong urges to pull
Why Is It So Hard to Stop Pulling?
Hair pulling can happen without conscious awareness. Some people only notice it once the damage is done. Others may feel the urge rise with emotional distress or sensory discomfort and pull as a way to cope.
Over time, the behavior becomes reinforced and automatic. It becomes difficult to interrupt the pattern without the right tools and support. But treatment can make a real difference.
How We Help at Resilience Counseling San Diego, CA
At Resilience Counseling, we specialize in helping individuals and families manage anxiety-based conditions, including trichotillomania. We help individual struggling learn tools and skills to help! Our treatment plans are personalized and evidence-based. Here are the key approaches we use:
Cognitive Behavioral Therapy (CBT)
CBT helps clients identify the thoughts, emotions, and triggers that contribute to hair pulling. It also teaches new ways to respond and reduce distress.
Habit Reversal Training (HRT) for trichotillomania San Diego, CA
HRT increases awareness of pulling behaviors and replaces them with healthier, more manageable alternatives. Clients learn specific tools to use when they feel the urge to pull.
COMB Model (Comprehensive Behavioral Model)
The COMB model is one of the most effective and individualized approaches we use for treating trichotillomania. It recognizes that no two people pull for exactly the same reasons, so treatment needs to be tailored to what is actually driving the behavior.
The COMB model addresses five key domains:
Sensory
Some people pull because of a specific physical sensation before or during pulling. They may be seeking the feeling of smoothness or tension release. We help identify these sensations and offer alternative strategies that meet the same need.
Cognitive
Pulling can be connected to thoughts like “Just one more won’t matter” or “This hair feels wrong.” We teach clients to recognize and challenge these thoughts using CBT tools.
Affective (Emotional)
Hair pulling often occurs in response to anxiety, frustration, boredom, or fatigue. We focus on emotional regulation skills to help clients manage these internal states in healthier ways.
Motor
Many clients pull in automatic, repetitive ways during activities like watching TV, reading, or lying in bed. We work to disrupt these motor patterns with alternative, intentional behaviors.
Place (Environmental Triggers)
Certain settings such as bathrooms, bedrooms, or desks often become pulling hotspots. We help clients identify and modify these environments to support recovery.By addressing all five domains, the COMB model creates a full picture of why pulling happens and what can be done about it.
You Are Not Alone
Trichotillomania can feel confusing and painful, but it is treatable. Many people feel tremendous relief when they start learning how to manage the behavior with professional guidance.
At Resilience Counseling, we approach treatment with compassion and practical strategies. We help clients move toward lasting change, one step at a time.
Trichotillomania treatment in San Diego, CA
Trichotillomania can feel confusing and painful, but it is treatable. Many people feel a lot relief when they start learning how to manage the behavior with a therapists guidance.
At Resilience Counseling, our team specializes in the treatment of Body-Focused Repetitive Behaviors (BFRBs), including trichotillomania (hair pulling) and dermatillomania (skin picking). We use the Comprehensive Behavioral (ComB) model, a gold-standard, evidence-based framework that explores the full range of factors contributing to these behaviors. This includes sensory triggers, emotional regulation patterns, cognitive beliefs, motor habits, and environmental influences.
By identifying each client’s unique presentation, we’re able to develop highly individualized treatment plans. Our goal is to address the underlying issues of the behavior, helping clients build new, coping tools they can use through their life.
Whether you’re seeking support for your child, teenager, or yourself, our therapists offer compassionate, research-informed care designed to help clients reduce urges, rebuild self-trust, and regain a greater sense of autonomy and well-being.
If you're ready to take the first step, we're here to help. Contact us today!
Author Bio: Katherine Pica OCD Therapy San Diego, CA
Katherine founder and clinical director of Resilience Counseling, a San Diego-based group practice specializing in OCD, anxiety, and trauma. She is highly trained in evidence-based approaches, including ERP, CBT, and the COMB model for Body-Focused Repetitive Behaviors (BFRBs). Katherine leads a dedicated team of therapists who are all trained extensively to treat BFRBs. . Together, the Resilience team provides compassionate, effective care for kids, teens, and adults working to break free from fear and live more empowered, meaningful lives.
Trichotillomania and OCD treatment
San Diego, CA
Disclaimer : The Content is not intended to be a substitute for professional and or medical advice, diagnosis, and or treatment. It is important to always seek the advice of your physician or other qualified health provider with any questions you may have regarding a mental health and/or medical condition. Never disregard any professional medical advice or delay in seeking it because of something you have read on the Resilience Counseling website. If you think you may have a medical emergency, call your doctor or 911 or local emergency number immediately.
