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

Trichotillomania is a neurobehavioral condition characterized by repetitive pulling of one’s hair, leading to significant hair loss and distress-1. The condition was initially understood as a bad habit or a branch of obsessive-compulsive disorder (OCD), but trichotillomania is now recognized with its unique features. Trichotillomania affects around 1–2% of the population, but it remains underdiagnosed and undertreated due to stigma and a lack of awareness2,3. The author conducted a literature review using PubMed, EBSCO, and Google Scholar in the time frame of 2000-2025, focusing on neurobiology, clinical studies, and treatments. After screening and analyzing the papers, we concluded three major directions of the latest research: dysregulated reward circuits, abnormal sensory processing, and potential genetic factors. These insights have spurred advances in treatment. Behavior therapy is the first-line treatment and can achieve significant symptom improvement. Meanwhile, pharmacological innovations targeting glutamatergic and dopaminergic pathways have also demonstrated impact where traditional selective serotonin reuptake inhibitors failed. Technology-centered interventions are expanding options for patients. This review synthesizes the latest findings on trichotillomania, 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 lack of data on trichotillomania. Finally, we discuss future directions to improve outcomes and close 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. Keywords: Trichotillomania; hair-pulling disorder; body-focused repetitive behaviors; habit reversal training; N-acetylcysteine; neuromodulation; memantine; digital therapeutics; public health gaps.