You have been doing it for years. You have never told anyone. You have probably never seen it written down as a real condition.
Trichotillomania (hair pulling) and dermatillomania (skin picking) are recognised mental health conditions, grouped with OCD. They involve repeated pulling or picking that causes visible damage, alongside repeated attempts to stop. They are far more common than their invisibility suggests, they are not a discipline problem, and there is treatment with real evidence behind it.
What they are
Both belong to a group called body-focused repetitive behaviours. The shape is consistent:
- A repeated behaviour directed at your own body — pulling hair from the scalp, eyebrows, eyelashes, beard or elsewhere; picking at skin, spots, scabs or the scalp
- Visible consequences: bald patches, thinning brows, sores, scarring
- Repeated attempts to reduce or stop, without success
- Significant distress, and usually considerable effort spent concealing it
Two modes, often in the same person. Automatic — it happens while you are reading, driving, on a call, and you notice only afterwards. Focused — deliberate, often in front of a mirror, sometimes triggered by tension and followed by relief and then shame.
The relief is genuine and it is why the behaviour persists. It is not enjoyed, exactly. It settles something, briefly, and the cost arrives afterwards.
What it is not
Not attention-seeking. Nearly everyone with these conditions hides them meticulously — hairstyles chosen to cover patches, brows drawn on, long sleeves in heat, avoiding swimming, avoiding hairdressers.
Not self-harm. The intent is different. These are not attempts to hurt yourself or to cope with emotional pain through injury, though they can coexist with it. If that is closer to what is happening for you, self-harm: understanding it and getting help is the more relevant piece.
Not simply a bad habit. Habits respond to deciding to stop. These do not, which is exactly the diagnostic point — the repeated failed attempts are part of the definition, not evidence of weakness.
Not rare. Estimates suggest one to two per cent of people are affected by hair pulling, with skin picking at least as common. In a country of this size that is a very large number of people, almost all of them convinced they are the only one.
Why nobody in Nigeria is diagnosed with this
There is essentially no public awareness of it here, which produces a predictable set of misreadings.
Suggested read: Hoarding: When Keeping Things Takes Over
Hair loss in patches gets attributed to relaxers, tight braiding, hair products, or a scalp infection — and treated repeatedly by dermatologists and hairdressers without anyone asking whether it is being pulled. Skin damage gets treated as acne, eczema or a reaction, with creams that cannot work because the mechanism is not dermatological.
In children and teenagers it is frequently punished. A child pulling out their eyelashes is scolded, sometimes beaten, occasionally taken for spiritual intervention. None of that reduces the behaviour, and shame reliably increases it.
Meanwhile the person concealing it concludes there is something uniquely wrong with them, because they have never encountered a name for it.
What drives it
Not fully understood, and several things are consistently associated:
- Genetics. It frequently runs in families.
- Tension and relief. Rising tension before, relief during. That cycle is what makes it self-sustaining.
- Stress, which reliably increases frequency — exam periods, bereavement, job pressure.
- Under- or over-stimulation. Many people pull or pick most in boredom or in intense concentration.
- Overlap with OCD, anxiety and depression, which are all more common alongside it. See OCD is more than being neat.
Treatment
The first-line treatment is a specific behavioural therapy — habit reversal training, usually delivered within a broader CBT approach. It has three parts:
Awareness training. Learning when it happens, since much of it is automatic. Usually starts with tracking — situations, times, emotional states.
Competing response. Substituting an incompatible action when the urge arrives, held for a short period until the urge subsides. Simple to describe, effective when practised consistently.
Managing the triggers. Changing the situations that reliably precede it, and addressing the stress underneath.
Newer approaches add acceptance-based work — tolerating the urge without acting on it, rather than fighting it — which suits people who have spent years in a losing battle with willpower.
Medication is sometimes used, particularly where OCD, anxiety or depression are also present, and that is a doctor’s decision. See therapy or medication.
Suggested read: Body Dysmorphia: When the Mirror Lies
What does not work: being told to stop, being punished, and covering the area without addressing the behaviour.
You can filter for OCD experience in our directory, and the OCD hub is the closest condition hub.
If it is your child
Do not punish it. That is the single most important thing. Punishment adds shame, shame adds stress, and stress increases the behaviour — a loop that is easy to start and hard to stop.
Say plainly that you have noticed, that it is a real thing many people do, that they are not in trouble, and that it can be helped. Then get an assessment rather than a hair treatment.
If it is you
It has a name, you are not the only one, and it is treatable. Most people who have carried this since childhood say the largest single relief came from learning it was a recognised condition at all — before any treatment started.
Telling one person is usually the hardest step and the one that changes things.
Frequently asked questions
Is hair pulling a mental health condition?
Yes. Trichotillomania is a recognised disorder grouped with OCD, and skin picking (dermatillomania) sits in the same category.
Is it the same as self-harm?
No. The intent differs, though the two can occur together. These behaviours are usually about tension and relief rather than about causing pain.
Will my hair grow back?
Often, though prolonged pulling in the same area can cause lasting damage. That is a reason to seek treatment earlier rather than a reason to despair.
How do I stop?
Willpower alone rarely works, which is part of the diagnosis. Habit reversal training within CBT has the strongest evidence.
Suggested read: Intrusive Thoughts: Why Your Mind Goes There
What should I do if my child is doing this?
Do not punish it. Tell them they are not in trouble, that it is a known condition, and arrange an assessment rather than treating it as a hair or skin problem.
