Trichotillomania Across Circuits: Neurobiology, Sensory Processing, and Genetic Insights

Trichotillomania, or hair-pulling disorder, is a neurobehavioral condition characterized by recurrent pulling of one’s hair, leading to noticeable hair loss and significant distress1. Once thought of as a mere habit or an offshoot of obsessive-compulsive disorder (OCD), trichotillomania is now recognized as a distinct entity with unique clinical and neurobiological features. It affects roughly 1–2% of the population, yet remains underdiagnosed and undertreated due to shame and limited awareness2,3. We conducted a literature review (PubMed, EBSCO, Google Scholar; 2000–2025) of neurobiology, clinical phenomenology, and treatments, including emerging digital and public-health interventions. Emerging research implicates dysregulated habits including reward circuits, abnormal sensory processing, and potential genetic factors in its pathophysiology. These insights have spurred advances in treatment. Behavior therapy is first-line and can achieve robust symptom improvement. Meanwhile, pharmacological innovations targeting glutamatergic and dopaminergic pathways have demonstrated efficacy where traditional serotonergic medications failed. Additionally, technology-enabled interventions are expanding options for patients. This review synthesizes the latest findings on trichotillomania’s neurobiology and treatment, highlighting how an integrative approach can address the disorder’s complex mechanisms. We also noticed that persistent gaps include stigma-driven underdiagnosis, limited provider training, and a paucity of large, mechanism-anchored trials. Finally, we discuss future directions with the goal of improving outcomes and closing current gaps in care.Keywords: Trichotillomania; hair-pulling disorder; body-focused repetitive behaviors; habit reversal training; N-acetylcysteine; neuromodulation; memantine; digital therapeutics; public health gaps.