If you pull your hair, you're not alone, and it isn't a lack of willpower. I've worked with clients with trichotillomania for 25 years at Noelle Salon in Melrose, just north of Boston. I'm not a doctor or therapist, but I've learned a lot from the people I work with about what actually helps.
Here are real strategies to reduce pulling, ways to protect your hair while it grows back, and where to find support.
Before and after at our salon.
What Is Trichotillomania?
Trichotillomania (TTM, or trich) is a hair-pulling disorder. It's one of a group of conditions called body-focused repetitive behaviors (BFRBs), along with skin picking and nail biting. Many people describe the urge like an itch that needs to be scratched, and pulling can bring a feeling of relief or calm, especially during stress or boredom. It often starts in childhood or the teen years.
Signs to Look For
- Thin or bald patches, often at the crown, the part, the hairline, the eyebrows or the lashes
- Short, broken hairs of different lengths in the same area
- Pulling without noticing, while reading, driving, studying or on a phone
- Playing with or examining pulled hairs
Why Crinkly or Wiry Strands Appear
Hair that grows back after pulling often comes in short, coarse and crinkly. Many clients tell me these strands feel different, and that makes them want to pull them even more. That's one reason a physical barrier can make such a difference.
Strategies That Help Reduce Pulling
- Track your triggers. Note when, where and how you pull. Patterns help you plan.
- Keep your hands busy. Keep fidgets, putty, a smooth stone or knitting where you usually pull: by the couch, the desk or the bathroom mirror.
- Use small goals. Delay pulling for two minutes, then five, then ten. Small wins add up.
- Block access at high-risk times. A soft hat, headband or gloves can interrupt automatic pulling.
- Work with a therapist. Habit reversal training (HRT) and cognitive behavioral therapy (CBT) are the main treatments for trich. Some people also use medication, which is a decision for you and your doctor.
Your Hair Can Help, Too
In my experience, the best results come from a blended plan: wanting to stop, working with a therapist, and using a hairpiece as a gentle barrier and reminder.
A hair topper or mesh integration system covers the area where you pull, so your fingers reach the hairpiece instead of your own hair. We attach it with small beads, never glue or shaving. Underneath, your own hair has a chance to grow back.
People sometimes ask, "Why not just wear a wig?" A wig is easy to take off during an urge, and it can be uncomfortable when you still have hair in other areas. An attached topper stays on, looks natural and keeps working as a barrier day and night.
Because hair often grows faster with trich, most of my trich clients come in about every 4 weeks. We remove the piece, wash and care for your own hair and the topper, and reapply it.
A hair system attached with small beads, which also acts as a barrier to pulling.
A finished topper, cut into a bob.
When the urge moves to other areas, I sometimes add hair extensions as part of the plan. A good haircut for trichotillomania can also help hide thin spots while you heal.
Where to Find Support
- Mass General Hospital, Center for OCD and Related Disorders (Boston). Specialized treatment for trichotillomania, including CBT and habit reversal training.
- Help for Hair Pullers by Nancy Keuthen, Ph.D. (of Mass General), Dan Stein, M.D., and Gary Christenson, M.D. I've given copies to clients because it helps you notice when pulling happens and how to change the pattern.
- International OCD Foundation (iocdf.org). Provider directories, support groups and education. The TLC Foundation for BFRBs has partnered with the IOCDF, which is expanding its BFRB resources.
- The TrichStop app. A step-by-step program to track patterns and reduce pulling.
- My private Facebook support group for people living with trichotillomania, thinning hair and hair loss. It's a safe place to ask questions and share progress. Read how the group helps.
- Not Alone Notes (notalonenotes.org). A nonprofit that sends notes of encouragement to people living with OCD and related conditions like trich. I met its founder in our salon, where she was writing these notes while waiting for a friend.
If you're a parent, see Helping Kids with Trichotillomania.
Recovery Is Possible
Progress isn't a straight line, and setbacks are normal. Read real client stories in Trichotillomania Recovery: What Happens After Hair Pulling Stops? and learn how to support regrowth in Trichotillomania Hair Regrowth.
A Private, Free Consultation
We'll meet in a private room, look at your hair, and talk about what might help, with no judgment.
Book a free, private trichotillomania consultation or learn more about our trichotillomania services. You can also email photos of your hair to noelle@noellesalon.com first.
Frequently Asked Questions
Why do I have random wiry or crinkly hairs?
Hair that grows back after being pulled often comes in short, coarse and crinkly. Those strands can feel different and trigger more pulling, so protecting them helps.
Can a hairpiece really help me stop pulling?
For many of my clients, yes. An attached topper or mesh system makes your own hair harder to reach, and it works best alongside therapy.
Do I need a doctor's diagnosis first?
No. You can come in for a consultation anytime. For treatment of the urges themselves, a therapist trained in habit reversal is the best place to start.
