Trichotillomania

Also called Hair pulling disorder, Skin picking disorder, Excoriation disorder

Repetitive hair pulling or skin picking that the person cannot stop. A recognised condition, not a habit.

What it is

Trichotillomania and skin picking disorder are body-focused repetitive behaviours: pulling hair or picking skin repeatedly, causing damage, and being unable to stop despite trying.

They affect around 1 to 2% of people, more often women, and usually start in adolescence.

They are frequently mistaken for self-harm, and they are different. The intent is not to hurt: the behaviour is often automatic, sometimes done while distracted, and it relieves tension or produces a satisfying sensation.

Shame keeps people silent for years, and the concealment is elaborate: hairstyles, makeup, clothing, avoiding swimming, wind and bright light.

Signs you might notice

Noticeable hair loss in patches, or thinning eyebrows and eyelashes.

Skin damage, scabs and scarring, most often on the face, arms or scalp.

Behaviour often done while watching television, reading or on the phone, with limited awareness.

Rituals around it: searching for a particular texture of hair, examining or swallowing what is pulled.

Failed attempts to stop, and distress about it.

Swallowing hair can cause a trichobezoar, a hair ball in the stomach, which is a surgical emergency.

How it can affect day-to-day life

The social cost is what people describe: avoiding swimming, wind, bright lights, intimacy, and having their hair touched.

Being told to just stop is the standard advice from families, and it lands as a statement that the person is not trying.

For people with a learning disability or autism, these behaviours are more common and are frequently managed with restriction rather than treatment. Look for pain, sensory need and anxiety first.

Supporting someone well

Do not tell somebody to stop, and do not point it out every time you see it. Both increase shame and neither reduces the behaviour.

Ask for habit reversal training, which is the treatment with the evidence: awareness training plus a competing response, done properly with a therapist.

Provide a sensory substitute: textured fidget items, a soft brush, something that meets the same need.

Reduce the triggers: mirrors, bright bathroom lights, and the specific settings where it happens.

Address the underlying anxiety.

Ask about hair swallowing specifically, because the surgical risk is real and nobody volunteers it.

Where to get help

A GP can refer to psychological therapy. In England, self-refer to NHS Talking Therapies and ask for habit reversal training.

TLC Foundation for Body-Focused Repetitive Behaviors and Mind both provide information.

Abdominal pain with a history of swallowing hair needs urgent assessment.