People with Trichotillomania describe experiencing an increase in tension prior to pulling hair or when trying to resist the urge to pull.
For many people with the disorder, hair pulling is a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, or tension, loneliness, or frustration. It can also occur in relatively emotionally uneventful times such as when one is bored or relaxed (e.g. reading a book or watching a movie).
Some may intentionally make time to pull hair with a certain goal in mind, such as pulling out all gray hairs or hairs of a certain texture. Some people may develop rituals for pulling hair, such as playing with it in some way, biting pulled hair, rolling it between their fingers or lips, or swallowing the hair. Hair pulling may also be done without intent to pull the hair out but only for the satisfaction of feeling the texture of the hair. When the hair is pulled, people describe experiencing immediate feelings of gratification and relief. As a result, sufferers continue to pull their hair to maintain these positive feelings.
People with Trichotillomania experience significant distress and shame. Distress may include feeling a loss of control, embarrassment, or shame and impairment may occur due to avoidance of work, school, or other public situations. Some people with Trichotillomania also pick their skin, bite their nails, or chew their lips.