How much hair is pulled out and where it is pulled from varies from person to person.
Some individuals with hair-pulling disorder have areas of complete baldness. Eyelashes and/or eyebrows may be missing. Other individuals merely have thinned hair. Individuals may change the spots they pull hair from over time.
Some individuals pull their hair out somewhat automatically, without thinking about it. Others are more conscious of the activity.
Individuals with hair-pulling disorder do not pull out their hair because they are concerned about their appearance and trying to fix it (as individuals with body dysmorphic disorder are). However, they may feel tense or anxious just before they do it, and hair pulling may relieve that feeling. Afterwards, they may feel gratified.
Many activities (rituals) may accompany hair pulling.
- Individuals may painstakingly search for a particular kind of hair to pull.
- They may roll the hair between their fingers, pull the strands between their teeth, or bite the hair once it is pulled.
- Many swallow their hair.
- The swallowed hair may form a lump that becomes stuck in the stomach or other parts of the digestive tract.
- These lumps, called trichobezoars, may make people feel prematurely full or cause nausea, vomiting, pain, and other digestive symptoms.
Many individuals with hair-pulling disorder also repeatedly pick at their skin, bite their nails, chew their cheek, or do other repetitive body-focused activities.
They may also have depression.
Affected individuals may feel embarrassed by or ashamed of the way they look or of their inability to control their behaviour.
They may try to camouflage the hair loss by wearing wigs or scarves. Some pull out hair from widely scattered areas to disguise the loss.
Individuals may avoid situations in which others may see the hair loss. They typically do not pull hair out in front of others, except for family members.
Individuals may also be distressed by their loss of control, and they usually repeatedly try to stop pulling their hair out.
Some individuals pull hair from other individuals or from pets or pull threads from clothing, blankets, or other textiles.
Individuals with hair-pulling disorder typically try to stop pulling their hair out or to do it less often, but they cannot.
Symptoms typically vary in intensity but may continue throughout life.