People with trichotillomania pull out the hair from their scalp, eyelashes, eyebrows, or other parts of the body resulting in noticeable bald patches. Individuals may begin hair pulling from one site and later start pulling from another area. Some people may pull hair from other people or from pets and others may play with or ingest the pulled hairs. These individuals often engage in other destructive behaviors concentrated on their body such as skin picking and nail biting. Their hair pulling may be transitory, episodic or unremitting such that weeks and months may elapse with a person being nearly or completely free of hair pulling, only to have a sudden and inexplicable recurrence. The intensity and severity of the hair pulling can also fluctuate and range from minimal hair loss to extensive cosmetic damage of total baldness. Although many people with trichotillomania pull their hair without any awareness of their behavior, others focus their attention on this activity. Specifically, some individuals concentrate their efforts on obtaining symmetry in their hair pulling or growth, such that they may pull the same amount of eyelashes from both eyes or attempt to even out their hair line or bald patch. Individuals may also be focused on the physical characteristics of the hairs as a preference for bristly new growth, long hairs, certain textures or colors, such as coarse or gray hairs, may exist. These individuals are frequently embarrassed and ashamed of their hair pulling and consequent appearance. They often wear wigs, scarves, hats, elaborate hairstyles and cosmetics to camouflage bald patches.

Trichotillomania is currently classified as an impulse control disorder in which the urge to pull hair is coupled with an increasing sense of tension. The act of hair pulling reportedly relieves that tension. However, the tension or urge consistently returns leading to a repeated pattern of pulling. Many individuals with trichotillomania characterize their behavior as a habit, much like biting nails or cracking knuckles. They describe the pulling as having both a soothing function and potentially distressing consequences. Negative emotions like anxiety, tension, anger, boredom and sadness may increase the tendency to pull hair and many individuals who pull out their hair also suffer from anxiety and depressive disorders. Thus, individuals with trichotillomania should have a comprehensive diagnostic assessment that evaluates all aspects of their life and functioning.

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