Questions built from the DSM-5-TR criteria for trichotillomania (hair-pulling disorder), with clinical detail from the MSD Manual and a peer-reviewed review of trichotillomania diagnosis and management.
The ten questions below come from the DSM-5-TR criteria for trichotillomania and from the features clinicians ask about when they assess it. Nothing you answer is saved or sent anywhere. A quiz can't diagnose you. It can tell you whether the thing you've been doing quietly for years lines up with a condition that has a name, a research base, and a treatment that works.
The quiz
Self-assessment
Question 1 of 10
Answer for the last twelve months rather than this week. Pulling comes in waves, and a bad month or a quiet month on its own won't give you a fair read.
Do you pull hair out of your own body for reasons that have nothing to do with grooming or shaping how it looks?
What your result means
8 to 10 yes answers: the pattern fits closely
At this level the pulling is happening, it has cost you hair, you've tried to stop, it carries shame, and it has started shaping decisions that have nothing to do with your hair. That combination has a name. The DSM-5-TR lists it as trichotillomania, in the same chapter as OCD and skin picking disorder. The longer write-up of what trichotillomania actually is covers the background this page assumes.
What a high score does not tell you is severity. Someone who pulls two eyelashes a day and someone who loses an hour every evening can both land here, because the criteria measure fit, not amount. Two people with identical scores can need very different amounts of help.
4 to 7 yes answers: real, but not the full picture
This is the most common range for people who go looking for a quiz like this, and the least satisfying to land in. It usually points to one of three situations. The pulling may be newer, so it hasn't yet reached into your social life or your time. It may be episodic, heavy for a fortnight and then absent for two months, which makes twelve-month questions hard to answer cleanly. Or the hair loss may genuinely be minor, sitting just below the line the criteria draw.
0 to 3 yes answers: the clinical pattern isn't there
A low score usually means one of two pieces is missing. Either the pulling isn't producing hair loss, or you've never had to try to stop because stopping was never in question. Shaping your eyebrows and yanking out grey hairs are things a lot of people do, and neither is trichotillomania.
There's a version of a low score still worth sitting with. If you pull rarely but it's growing, or if the honest answer to several questions was "not yet", keep the page. Patterns drift, and a baseline taken while things are mild is more useful than one taken during your worst month.
What the ten questions measure
The DSM-5-TR sets out five criteria for trichotillomania. Written for a clinician they're dense. In plain terms they run like this.
Hair pulling that causes hair loss. Pulling from anywhere on the body counts. Scalp is the most common site, then eyebrows and eyelashes, though arms, legs, beard and pubic hair all appear. The loss doesn't have to be visible to anyone else. Some people pull from one concentrated spot and end up with a patch; others spread the pulling across a wide area on purpose so the thinning stays hidden. Both meet the criterion.
Repeated attempts to stop or cut down. The trying counts as much as the pulling does. It's what separates a disorder from a choice, and it's why cosmetic plucking never qualifies no matter how often somebody does it.
Distress or impairment. The pulling reaches past your hair. That might be shame, lost time, avoided swimming pools, a hairdresser you've stopped booking, or a relationship you've kept at arm's length over what someone might see.
Not explained by a medical condition. Several dermatological conditions cause hair loss, and one of them resembling pulling doesn't make it pulling.
Not better explained by another mental disorder. Hair removal driven by a perceived flaw in appearance points to body dysmorphic disorder instead. Pulling done to complete a symmetry ritual points to OCD.
Those last two are exclusions, and a yes/no quiz can't score them. That's the honest limit of what you just took, and it's most of what the next section is about.
Why "tension then relief" is missing from that list
That change matters for anyone self-assessing today. If your pulling happens quietly while you read or scroll, with no urge you could name and no relief you could point to, the older checklists would have thrown you out, and some online quizzes still will. One style has your hand arriving before your awareness does. The other has you deliberately hunting for a particular hair by feel. Neither is the more legitimate version, and if you want to work out which situations pull which style out of you, the pattern behind hair-pulling triggers is the next thing to read.
What it isn't
The two exclusion criteria are why a self-assessment shouldn't be the end of this. Hair loss has causes with nothing to do with pulling, and several of them are treatable in ways that pulling is not.
Alopecia areata produces smooth, round patches, usually with clean edges and no broken hairs standing in them. Pulling tends to leave the opposite: an irregular shape, often within easy reach of your dominant hand, containing stubble at uneven lengths.
Tinea capitis, a fungal scalp infection, causes scaling and broken hairs and is far more common in children. It needs an antifungal, not behavioral work.
Telogen effluvium is diffuse shedding after illness, childbirth, surgery, or a stretch of high stress. Hair comes out in the shower and on the pillow rather than between finger and thumb.
Traction alopecia comes from tight braids, extensions, or ponytails, and shows along the hairline.
Body dysmorphic disorder can drive hair removal, but the aim is correcting a flaw the person believes is there. The intent stays cosmetic even when the removal is severe.
OCD can also drive pulling, usually to even something out or to answer an intrusive thought. The relief comes from the thought settling, not from the pull itself.
The question most quizzes skip
What happens to the hair after it's out is clinically relevant and almost never screened for. Some people drop it. Some roll it between their fingers, run the root across their lips, or bite the bulb off. Some swallow it.
Swallowing hair, trichophagia, is worth raising with a doctor on its own, separately from anything to do with therapy. Hair isn't digestible. Over months or years it can build into a trichobezoar, a mass in the stomach that doesn't pass, and the complications from that point are surgical rather than psychological. It's uncommon. It's also the one part of this that working on the behavior alone won't fix.
Quick Check
What happens to the hair after you pull it?
Persistent stomach pain, nausea, vomiting, or feeling full after very little food, in someone who swallows hair, is a reason to see a doctor and say the word trichophagia out loud rather than describing the symptoms alone.
What to do next
If you scored low
Keep an eye on it, and otherwise carry on. If the pulling holds where it is, that's genuinely fine. If it starts climbing, you'll catch it earlier than most people do, because you now know what the criteria are asking about.
If you scored in the middle
This is the tier where structure earns the most, because the pattern is established enough to work with and not yet worn deep. The first move isn't restraint. It's information. Two weeks of noting when you pull, where on the body, and what was happening in the ten minutes beforehand will tell you more about your own pattern than another year of trying to stop will.
That's the awareness-training stage of habit reversal training, the treatment with the strongest evidence behind it for hair pulling. Awareness first, then a competing response you can do with your hands when an urge arrives, then changes to your surroundings that make pulling harder to start. A notebook does the job. So does an app. If you'd rather read the full protocol before picking a tool, the walkthrough on how to stop pulling hair lays it out step by step.
If you scored high
The strongest first step is telling one person who can do something with the information. A clinician who has heard of BFRBs is the best version of that, and the International OCD Foundation (iocdf.org), which now hosts the TLC Foundation's BFRB resources, keeps a directory of practitioners trained in them. If therapy isn't available to you right now, for cost or geography or because you're not ready to say it out loud, self-directed habit reversal work is a real starting point rather than a consolation prize. Plenty of people begin there and add a therapist later.
Alongside that, get the hair loss itself looked at, for the reasons in the differential above.
SkinAware is built for this stage of it. You log pulling episodes in a few taps, log the urges you resisted, and work through habit reversal modules at your own pace, with progress tracking and an optional accountability friend if going it alone is what's kept you stuck. It covers hair pulling, skin picking and nail biting, which matters because most people who pull also do at least one of the others. If skin picking is in the mix for you too, there's a separate self-assessment for skin picking built the same way.
Frequently asked questions
No. It can tell you whether your pattern matches the criteria. A diagnosis needs a clinician who can rule out the medical causes of hair loss and check that another condition isn't the better explanation for the pulling.
Possibly. The criterion is hair loss, not visible bald patches. Diffuse thinning counts, and so does loss you've spread out or styled around on purpose. Hidden hair loss is explicitly included in the DSM-5-TR wording.
No, although they sit in the same DSM-5-TR chapter and often occur together. OCD pulling is performed to neutralise a thought, and the relief comes from the thought settling. Trichotillomania pulling is its own end.
Site preference varies between people and often shifts over the years for the same person. Eyebrows and eyelashes are the most common sites after the scalp, and pulling from more than one site at once is normal.
Usually, where the follicle hasn't been permanently damaged. Repeated pulling from the same spot over many years can scar the follicle, and scarred follicles don't resume normal growth. A dermatologist can tell you which kind of loss you have by looking.
ADHD and hair pulling co-occur more often than chance would predict. Most people with trichotillomania have at least one other condition alongside it, commonly anxiety, depression, ADHD, or another body-focused repetitive behavior.
If it makes the conversation easier to start, yes. A lot of people find it simpler to point at the criteria than to describe the behavior from scratch.