Trichotillomania can go into remission-like states where the individual may not experience the urge to "pull" for days, weeks, months, or even years.

Individuals with trichotillomania may be secretive of the hair pulling behavior, which is often associated with feelings of shame.

[10] An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing, due to appearance and negative attention they may receive.

[14] Some people with trichotillomania wear hats, wigs, false eyelashes, use makeup such as an eyebrow pencil, or style their hair in an effort to avoid such attention.

[15] Some individuals with trichotillomania may feel isolated, as if they are the only person with this problem, due to low rates of reporting.

Hair pulling can lead to tension and strained relationships with family members and friends.

[17] Other medical complications include infection, permanent loss of hair, repetitive stress injury, carpal tunnel syndrome, migraines, and gastrointestinal obstruction as a result of trichophagia.

[10] Rapunzel syndrome is an extreme form of trichobezoar in which the "tail" of the hair ball extends into the intestines and can be fatal if misdiagnosed.

[21][22] A common example of a sedentary activity promoting hair pulling is lying in a bed while trying to rest or fall asleep.

Another school of thought emphasizes hair pulling as addictive or negatively reinforcing, as it is associated with rising tension beforehand and relief afterward.

This can make diagnosis difficult as symptoms are not always immediately obvious, or have been deliberately hidden to avoid disclosure.

An alternative technique to biopsy, particularly for children, is to shave a part of the involved area and observe for regrowth of normal hairs.

These conditions may share clinical features, genetic contributions, and possibly treatment response; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile.

For these children, hair-pulling is considered either a means of exploration or something done subconsciously, similar to nail-biting and thumb-sucking, and almost never continues into further ages.

In young adults, establishing the diagnosis and raising awareness of the condition is an important reassurance for the family and patient.

When trichotillomania begins in adulthood, it is often associated with other mental disorders, and referral to a psychologist or psychiatrist for evaluation or treatment is considered best.

[41] The United States Food and Drug Administration (FDA) has not approved any medications for trichotillomania treatment.

[44] Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have limited usefulness in treating trichotillomania, and can often have significant side effects.

[10] There is little research on the effectiveness of behavioral therapy combined with medication and robust evidence from high-quality studies is lacking.

[49] When it occurs in early childhood (before five years of age), the condition is typically self-limiting and intervention is not required.

[9] In adults, the onset of trichotillomania may be secondary to underlying psychiatric disturbances, and symptoms are generally more long-term.

[10] Hair pulling was first mentioned by Aristotle in the fourth century B.C.,[51] was first described in modern literature in 1885,[52] and the term trichotillomania was coined by the French dermatologist François Henri Hallopeau in 1889.

[3][9] In 1987, trichotillomania was recognized in the Diagnostic and Statistical Manual of the American Psychiatric Association, third edition-revised (DSM-III-R).

[53] Support groups and internet sites can provide recommended educational material and help persons with trichotillomania in maintaining a positive attitude and overcoming the fear of being alone with the disorder.

[57] The trichotillomania of a prominent character is a key plot element in the 1999 novel Whatever Love Means by David Baddiel.

[citation needed] Ashley Barret, a character portrayed by Colby Minifie in the superhero fiction series The Boys, is shown suffering from it.