Family guide · With Daisy & Trixie
OCD and trichotillomania:Similarities and differences.
OCD and trichotillomania can affect the same person, which can make them difficult to tell apart. This guide explains what they share, how their patterns differ, and where families can learn more.
If someone has OCD, do they also have trichotillomania? And vice versa?
No. Some people have one condition; others have both. OCD and trichotillomania are separate diagnoses within the group called obsessive-compulsive and related disorders. Trichotillomania, or hair-pulling disorder, is a body-focused repetitive behavior (BFRB). A clinician can assess each condition separately. Read IOCDF’s explanation of BFRBs.
About this guide: Written from a parent’s perspective for awareness and education. A qualified clinician should assess individual symptoms and treatment needs. This page has not been clinically reviewed.
What do OCD and trichotillomania have in common?
Both can involve repetition that is difficult to interrupt, significant distress, and disruption to everyday life. Much of that experience may be hidden. What looks small to someone watching can take up a great deal of the person’s day.
As a parent, it can be easy to focus on what we see and want it to stop. Asking what the experience feels like can help open a more useful conversation.
See NIMH’s OCD overview and IOCDF’s description of hair-pulling disorder for their impact on daily life.
OCD and trichotillomania: key differences
The comparison below describes common patterns. A clinician looks at how symptoms work together in the individual.
What is the central pattern?
- OCD
- Obsessions are recurring, unwanted thoughts, images, or urges. Compulsions are actions or mental rituals used to reduce distress or respond to an obsession.
- TRICHOTILLOMANIA
- Repeated hair pulling that causes hair loss, with attempts to reduce or stop and significant distress or interference. Assessment also considers other possible explanations.
What can be happening underneath?
- OCD
- Anxiety, disgust, uncertainty, and a “not just right” feeling can all be part of OCD.
- TRICHOTILLOMANIA
- Pulling can involve sensations, thoughts, emotions, learned movements, and surroundings. Some pulling is focused; some happens outside awareness. The mix varies from person to person.
What might other people miss?
- OCD
- Compulsions can be mental, such as silently reviewing or counting. The struggle may be hard to see.
- TRICHOTILLOMANIA
- Pulling may happen during ordinary activities such as reading. Someone may only notice afterward and may conceal hair loss.
Clinical background: IOCDF on obsessions and compulsions; IOCDF on BFRBs; Mansueto and Golomb on the ComB model.
OCD and hair pulling in everyday life
Here are two fictional examples using our characters. Individual experiences vary.
Daisy: “But what if I said something wrong?”
Daisy keeps replaying a conversation in her mind, hoping one more review will settle her doubt. She may look quiet while she mentally reviews the conversation again and again.
Trixie: “I didn’t realize my hand was there.”
Trixie is absorbed in a book when she notices she has been pulling. At other times, a particular hair texture catches her attention. The same person can notice different patterns.
When someone has OCD and trichotillomania
Both conditions can occur together. An assessment can consider each pattern and its effect on daily life. IOCDF discusses conditions that can co-occur with BFRBs.
It helps to describe each experience, even if a diagnosis is already part of the conversation.
What might professional care involve?
For OCD, exposure and response prevention (ERP) is a well-studied form of cognitive behavioral therapy. For BFRBs, behavioral approaches include habit reversal training (HRT) and Comprehensive Behavioral (ComB) treatment.
These are names you may hear in an appointment. Ask a qualified clinician how they apply to your situation.
Learn more from NIMH on OCD treatment and IOCDF’s clinician-written overview of HRT and ComB.
Where can a parent or loved one start?
A conversation can start with what you have noticed and what your loved one wants to share.
“I want to understand what this is like for you. What would you like me to know?”
Use words that feel natural in your family, and give the person time to answer.
- For the conversation: explore listening when your child opens up about OCD or talking about hair pulling without blame.
- For an appointment: you could ask, “Do you have experience assessing both OCD and BFRBs?” and “How would you help us understand the different patterns?”
- For further information: our Trusted Resources connect families to established organizations and professional directories.
For parents and loved ones, listening and asking questions are useful places to begin.
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Download the free trichotillomania guide
Our trichotillomania family awareness guide brings Trixie and Maverick together with plain-language information, conversation examples, and places to learn more.
PDF · Family awareness and conversation examples about trichotillomania.
Sources & further reading
- International OCD Foundation: What is OCD? Obsessions, compulsions, and distress.
- International OCD Foundation: Body-Focused Repetitive Behaviors Hair pulling, classification, and co-occurring conditions.
- Charles S. Mansueto, PhD, and Ruth G. Golomb, LCPC: Comprehensive Behavioral (ComB) Treatment Individual pulling patterns and behavioral approaches.
- National Institute of Mental Health: OCD information booklet Symptoms, assessment, and treatment information.
Sources checked October 27, 2026. The fictional character scenes and conversation examples were written for this guide. Links are provided for reference and do not imply endorsement of What’s the Trich.