Yes, hair pulling (Trichotillomania) is often a sensory experience, involving tactile sensations like hair texture, visual cues, sounds (snap of the hair), or even taste/smell, acting as a self-regulation mechanism to manage anxiety, boredom, or overstimulation by providing specific sensory input or relief. Many individuals with hair pulling have sensory over-responsivity, and pulling helps balance their internal state, sometimes satisfying a need for perfection (like an "out-of-place" hair) or providing a pleasurable sensory reward.
Across those with trichotillomania, there could be many reasons that trigger the need to pull hair. These triggers could be a need for, or reaction to, a sensory feeling, the experience of an unpleasant emotional feeling, or having thoughts that cause distress.
Stimulation Substitutes for Trichotillomania
Repetitive behaviors such as hair pulling and skin picking are quite often seen in individuals on the Autistic Spectrum and can be difficult for parents and educators to manage. These behaviors are a form of stimming that provide needed sensory input for people on the spectrum to help calm or regulate themselves.
And do you know what else is frequently linked to low dopamine? ADHD! Because of this, people with ADHD often engage in what's known as dopamine-seeking behavior. For some, that can look like indulging in food, sex, or drugs; but repetitive behaviors, like hair-pulling, can also provide a dopamine boost.
The ADHD "30% Rule" is a guideline suggesting that executive functions (like self-regulation, planning, and emotional control) in people with ADHD develop about 30% slower than in neurotypical individuals, meaning a 10-year-old might function more like a 7-year-old in these areas, requiring adjusted expectations for maturity, task management, and behavior. It's a tool for caregivers and adults with ADHD to set realistic goals, not a strict scientific law, helping to reduce frustration by matching demands to the person's actual developmental level (executive age) rather than just their chronological age.
While skin-picking and hair-pulling are typically associated with OCD and classified as an obsessive and compulsive-related disorder, it can also occur in the context of ADHD. Skin-picking, hair-pulling, and nail-biting may be related to anxiety, sensory stimulation, and impulsivity.
Around 90% of autism cases are attributed to genetic factors, meaning autism is highly heritable, with many different genes contributing, rather than a single cause, often interacting with environmental influences during early brain development, though specific environmental factors don't cause it but can increase risk. Twin studies show strong genetic links, with concordance rates between 60-90% in identical twins, and research points to complex interactions of many genes and prenatal/perinatal factors.
Things you can try yourself
Poor Motor Skills or Coordination
Sensory processing issues often affect motor development: Clumsiness, frequent tripping, or difficulty navigating spaces. Struggles with fine motor tasks, such as writing, cutting, or buttoning. Avoiding sports or physical activities that require coordination.
The "6-second rule" for autism is a communication strategy where a speaker pauses for about six seconds after asking a question or giving information, giving the autistic person extra time to process it without feeling rushed, which helps reduce anxiety and allows for a more thoughtful response, reducing frustration for both parties. Instead of repeating or rephrasing, which can be confusing, you wait, and if needed, repeat the exact same words after the pause.
What to do about hair pulling
What are the early warning signs for autism spectrum disorder? The early warning signs for an ASD include concerns about a child's social skills, communication, and restricted or repetitive patterns of behaviors, interests, activities, and emotional regulation.
Trichotillomania can be related to emotions, including: Negative feelings. Pulling out hair may be a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, boredom, loneliness, extreme tiredness or frustration. Positive feelings.
Five key signs of autism (ASD) involve difficulties with social communication, repetitive behaviors, intense interests, sensory sensitivities, and strict routines, such as trouble with small talk/eye contact, hand-flapping/lining things up, deep focus on specific topics, sensitivity to sounds/lights, and distress over schedule changes, though these vary widely.
Yes! Although they sound similar, sensory processing issues can be present without autism. Often children or adults with other neurodevelopmental or psychiatric conditions such as Developmental Delay, Intellectual Disability, Anxiety, ADHD, or mood disorders can also exhibit Sensory Processing Disorder.
Despite the emotional toll, you are not alone—approximately 5% of the U.S. population is affected by Trich. In fact, several well-known public figures have openly shared their experiences, including Olivia Munn, Megan Fox, Charlize Theron, Katy Perry, Victoria Beckham, and Justin Timberlake.
Trichotillomania is part of OCD and is thought to be largely related to anxiety disorders. There have been twin studies that have demonstrated genetic anomalies associated with trichotillomania and other OCD-related disorders.
Some of the repetitive BFRBs that can also be classified under stimming include skin picking, nail-biting, and hair pulling since they are often repetitive and occur as a response to stress or anxiety.
While the exact reasons are not yet clear, changes in how the disorder is defined, increases in screening, and more awareness certainly contribute to this increase. If you have any concerns about your child's development, speak to a healthcare professional about diagnostic tests.
Additionally, inherited genetic variations contribute greatly. Research shows that both mothers and fathers can carry autism-related gene variants. Some of these are common variants that increase the risk of autism, while others are rare mutations causing more severe effects.
Autism in young children
The ADHD "2-Minute Rule" suggests doing any task taking under two minutes immediately to build momentum, but it often backfires by derailing focus due to weak working memory, time blindness, and transition difficulties in people with ADHD. A better approach is to write down these quick tasks on a separate "catch-all" list instead of interrupting your main work, then schedule specific times to review and tackle them, or use a slightly longer timeframe like a 5-minute rule to prevent getting lost down "rabbit holes".
The top 3 core symptoms of ADHD are inattention (difficulty focusing, staying organized), hyperactivity (excess restlessness, excessive movement), and impulsivity (acting without thinking, poor self-control). People with ADHD often experience a combination of these, though some might primarily struggle with inattention (inattentive type) or hyperactivity/impulsivity (hyperactive-impulsive type).
The 15-Minute Rule for OCD is a Cognitive Behavioral Therapy (CBT) technique where you delay performing a compulsion for 15 minutes when an obsessive thought triggers anxiety, allowing the urge to lessen naturally as you practice exposure and response prevention (ERP). It teaches your brain that discomfort decreases without the ritual, building resilience and breaking the obsessive-compulsive cycle by gradually increasing tolerance for uncertainty and distressing feelings.