Blessing is a 22-year-old single lady who pulls hair from the crown of her head on a daily basis. She began pulling at her eyebrows at age 14, but the pulling shifted to her head and became a daily routine during the past 3 years. Blessing tends to pull her hair during times of stress, but only on approximately 50% of occasions is she aware that she is doing it. The rest of the time, she reports, she pulls “automatically” and then notices a pile of hair on the floor or on her desk after she has “snapped out of it.” Blessing often pulls her hair for 1–2 hours each day. The urge to pull immediately precedes or is simultaneous with touching the hair, and she reports that she is generally unable to resist this urge. The pulling episode usually ends when she feels the “right” tugging sensation and then sees a “good” root. She then plays with the hair, caressing her lips with the hair shaft and the root and then ingesting the hair. The feeling of accomplishment from the pulling quickly turns into shame and embarrassment. Because of the alopecia from pulling, Blessing does not date, and she limits her social activities to only a few friends.
Trichotillomania also called hair-pulling disorder, is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. It is characterized 1. by recurrent pulling out of one’s hair resulting in hair loss. 2. Repeated attempts to reduce or stop the hair pulling. 3. The hair pulling causes significant distress or impairment in occupational, social or another areas of functioning 4. The hair pulling or hair loss is not attributable to another medical condition. 5. The hair pulling is not better explained as a symptom of another mental disorder.

Signs and symptoms of trichotillomania often include:
Repeatedly pulling of hair, typically from scalp, eyebrows or eyelashes, but sometimes from other body areas, and sites may vary over time
An increasing sense of tension before pulling, or when trying to resist pulling
A sense of pleasure or relief after the hair is pulled
Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
Biting, chewing or eating pulled-out hair
Many people who have trichotillomania also pick their skin, bite their nails or chew their lips. Sometimes pulling hairs from pets or dolls or from materials, such as clothes or blankets, may be a sign. Most people with trichotillomania pull hair in private and generally try to hide the disorder from others. Some people pull their hair without even realizing they’re doing it, such as when they’re bored, reading or watching TV.—a phenomenon known as “automatic” pulling. “Focused” pulling, in contrast, occurs when individuals pull their hair intentionally to relieve tension or distress. For example, pulling hair out to get relief from the overwhelming urge to pull hair.

The cause of trichotillomania is unclear. However, Family history, Stressful situations or events and other disorders such as depression, anxiety or obsessive-compulsive disorder (OCD) tend to increase the risk of trichotillomania

Individuals with trichotillomania reported Low self-esteem, depression, anxiety, and alcohol or street drug use, feelings of unattractiveness, shame, guilt, isolation, pain, fear and concern regarding the concealment of the disorder. It also significantly impacts academic, social and work functioning. It may lead to difficulty studying, absence from school, avoidance of intimate relationships, social activities and job opportunities.