Hair Pulling (Trichotillomania): What Treatments Work, From Trials
HairArticleTrichotillomania, repeatedly pulling out your own hair, is treatable, though many people feel clinicians know little about it. A review of 24 trials with 857 people found behavioral therapy built on habit reversal training had the largest benefit. Among medicines, N-acetylcysteine, an amino acid, helped 56% of people in one trial against 16% on placebo. Here is what the evidence shows.
Trichotillomania is repeated pulling out of your own hair, enough to cause noticeable hair loss.1 It can feel impossible to stop and hard to talk about. People with it often feel clinicians know little about it,2 but there’s solid evidence on what helps.
Habit reversal training leads
A 2020 review pooled 24 randomized trials with 857 people.2
- Behavioral therapy with habit reversal training had the largest benefit and the strongest evidence.2
- An earlier review of 11 trials also found a large effect for behavioral therapy, bigger with more therapy hours.3
Medicines
There’s no medicine approved specifically for hair pulling.2 Single trials have found benefit from:2
- N-acetylcysteine (NAC)
- Clomipramine, an older antidepressant
- Olanzapine, an antipsychotic
Each needs repeating in more trials.2
The NAC trial
In a 12-week trial, 50 adults, 45 of them women, took NAC (1,200 to 2,400 mg a day) or a placebo.1
| NAC | Placebo | |
|---|---|---|
| Much or very much improved | 56%1 | 16%1 |
Improvement first showed up around week 9, so patience matters.1
Where to start
- Ask for behavioral therapy with habit reversal training; it has the best evidence.2
- Ask about NAC if therapy isn’t enough or isn’t available, and check it’s safe with your other medicines.1
- Expect weeks, not days, for any change.1
- Track your pulling by time, place and mood to spot triggers.
See also hair pulling care questions.
Try: “I’ve been pulling out my hair for years, mostly when I’m stressed or bored. Can you refer me for habit reversal training, and would NAC be worth trying?”
Hair, Everywhere encourages plain language about hair worries in Chapter 3, “Is This Just Vanity?,” in a section called “What to Say When It Feels Vain.” Its Hair Log keeps monthly photos and dated notes, so you can see regrowth as pulling eases. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Talk to a doctor before taking N-acetylcysteine or any medicine for hair pulling, especially if you're pregnant or take other medicines. See a dermatologist for patchy hair loss you're not causing, since other conditions can look similar. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Archives of General Psychiatry (abstract via PubMed), 2009N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study (opens in a new tab)abcdefg
- Depression and Anxiety journal (abstract via PubMed), 2020Pharmacological and behavioral treatment for trichotillomania: An updated systematic review with meta-analysis (opens in a new tab)abcdefg
- Journal of Psychiatric Research (abstract via PubMed), 2014Treating trichotillomania: a meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors (opens in a new tab)↩
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