Past ten at night in her bedroom, Ploy is reading through a report due tomorrow. One hand scrolls the screen while the other has moved up to her hair — she is not sure when.

Her fingers search for a while. Not any strand: it has to be one that feels coarse and kinked. When she finds it, she pulls it out, and the tightness held in her chest eases for a moment. Before long her fingers begin searching for the next. By the time she notices, there are pulled hairs scattered across the bed. Looking in the mirror the next morning, Ploy has to part her hair differently so that the hair on top covers the thinning patch at her crown — a patch she knows perfectly well the origin of.

She has postponed her hair appointment three times because she does not want the stylist to see the thin patch at her crown. She could not go to the beach with friends for fear the wind would part her hair. And she has never told anyone about this, because how could she explain why she damages her own hair when she does not want to?

If you have ever been where Ploy is, the first thing to know is that you are not strange, not unwell in the mind, and not weak. Trichotillomania, or hair-pulling disorder, is a genuine condition, and a considerable number of people are facing it quietly too.

What trichotillomania is, and how it differs from ordinary hair pulling

Trichotillomania is classified among the obsessive-compulsive and related disorders. It is usually discussed under the group of body-focused repetitive behaviours (BFRBs), alongside behaviors such as nail biting and skin picking.

What distinguishes it from playing with your hair or idly pulling a strand is its pattern: a person pulls hair repeatedly until there is noticeable hair loss or thinning; they have tried to control themselves or to stop many times without success; and it causes distress or affects their life — their confidence, their social life, or their work.

Pulling can occur at several sites: the scalp, the eyebrows, the eyelashes, and hair elsewhere on the body. Many people have highly specific criteria — it must be a coarse strand, a kinked strand, or one that feels unlike the others to the touch. Some pull with full awareness at moments when inner pressure is high, while many others pull without noticing while reading, watching a series, or driving, realizing only on seeing the small pile of hair beside them. And a great many people experience both forms mixed together.

The tension-release cycle: why pulling makes stopping harder

The heart of this condition for many people is what is called the tension-release cycle. Before pulling, they usually feel a tightness inside, a discomfort, or a restlessness accumulating — thinking and worrying. Some describe it as something caught at their fingertips. On pulling, that feeling eases for a moment. Some feel relief; some feel a satisfaction they cannot quite describe. And it is that momentary relief that pays the brain a reward, teaching it that pulling hair is the way out of anxious thought. So the cycle turns again and again.

Many people then face regret, disappointment, or anger at themselves almost the instant a hair is pulled out — and those bad feelings become a new mass of anxiety awaiting release. The cycle therefore does not turn only once; it turns in a spiral, and the harder a person blames themselves, the tighter the spiral becomes. This is why scolding yourself severely has almost never been the way out, and usually makes everything worse.

The valve on a pressure cooker

An image that helps explain this cycle is a pressure cooker with a single release valve.

When the flame of stress, of pent-up feeling, or of restlessness burns underneath, pressure accumulates in the pot. And the only valve this system knows is pulling. Open the valve once, and pressure drops sharply — then accumulates again. The problem with simply forbidding yourself is that it amounts to holding a hand over the valve while the flame beneath burns exactly as before. The pressure has not gone anywhere. It is only waiting for a day when it pushes harder than before. A sustainable way out therefore has two parts that must be done together: gradually turning the flame beneath down, and installing additional release valves, so that the system has more than one way out and no longer depends on the original valve alone.

The unseen weight: concealment and shame

What people around them usually do not know is the enormous energy spent on hiding hair that is gradually thinning. Parting the hair a new way every morning. Choosing a hairstyle on the basis of which thin spot needs covering. Avoiding swimming pools, strong wind, and even a hairdresser’s hands. Sitting in the corner of a room where the light does not fall on the thinning patch. All of this is a burden carried daily with nobody seeing it.

And concealing thinning hair every day costs more than the exhaustion it consumes. Over time the belief that "this is too shameful to tell anyone" becomes more deeply embedded, and the isolation grows — when in truth this condition is more common than people think, and most of those facing it are ordinary people living their lives, working, and studying perfectly normally. The shame that arises is only a by-product of having had to keep one thing to oneself for too long.

When is it worth seeing a doctor or specialist?

If pulling has led to noticeable hair loss or thinning, or if you have tried to stop on your own many times without success, or if this condition has begun to determine where you can and cannot be, what you can and cannot wear, and who you can and cannot see — that is a signal that you should receive care from a mental-health professional.

The good news is that this condition has approaches to care supported by research, particularly habit reversal training (HRT), which trains awareness, identifies triggers, and builds an alternative response in place of pulling. As for the hair and scalp, a dermatologist can help assess the scalp, rule out other causes of hair loss, and care for any skin complications.

To emphasize again: seeing a specialist is nothing to be ashamed of. It is taking a burden carried alone for a long time and setting it down somewhere there are people to help carry it. And if psychological distress at any point becomes more than you can manage alone, Thailand’s mental health hotline, 1323, is available for consultation twenty-four hours a day.

The role of hypnotherapy in caring for trichotillomania

From our experience with the people we work with, work on this condition in the therapy room usually runs along the same path as the pressure-cooker image. On one side, turning down the flame beneath: caring for the stress, the anxiety, and the pent-up feeling that fuel the pressure. On the other, training a person to catch the first signal in time — the moment a hand begins to lift, or fingers begin searching for a strand — and then linking that moment to a new response that does not harm the hair, so the system has more than one valve. And a part no less important is working with shame and with the image a person holds of themselves, because as long as every lapse ends in severe self-judgment, the spiral of the cycle only tightens further.

At NBRH we work from the principle of Neuro-Behavioral Repatterning & Hypnotherapy: changing the response patterns of the nervous system and of behavior in a structured way. Easing the tension-release cycle sustainably does not come from holding a hand over the valve out of shame. It comes from turning down the flame of the stress beneath, installing new routes of release for the nervous system to choose from, and setting self-judgment down a little at a time — until one day the pressure in the pot no longer needs the original valve at all. That is what lasting change means here.

If you are wondering how this group of behaviors works more broadly, “Nail Biting: Why the Hand Moves on Its Own” looks at the mechanism of automatic behavior from a lighter angle. And if shame is the heaviest part of this for you, “Shame: When the Voice Inside Says We Are Not Enough” fills in that part of the picture.

Trichotillomania: Why Hair Pulling Is So Hard to Stop