How common are bald patches in hair pulling disorder?

Hair pulling disorder can produce irregular patches rather than neat circles. A clinician may see hairs at different lengths, broken stubble, sparse areas and sometimes irritated skin. Pulling can happen consciously or during activities such as reading, working or falling asleep; some people describe tension before pulling or relief afterward, while others notice only the result.

The scalp may be otherwise clear, but repeated pulling can cause soreness, scabs or infection. Patchy loss also occurs with immune conditions and infections, so an examination helps separate pulling-related damage from other explanations.

Arrange a dermatology or mental-health assessment if pulling feels difficult to control, causes distress or leaves repeated patches. Note when pulling happens, what you feel beforehand, and whether touching, twisting or checking the hair is part of the pattern. This information can guide behavioural treatment.

Keep nails short, cover or style the affected area gently, and use a soft substitute for the hands during common trigger activities. Avoid tight coverings that rub the scalp. Do not shame or punish yourself or a child; supportive language makes it easier to discuss the behaviour and seek help.

Seek prompt medical care for bleeding, pus, spreading redness, severe pain or rapidly worsening scalp injury. Contact a mental-health professional urgently if pulling is linked with overwhelming distress, self-harm thoughts or inability to stay safe. Swallowed hair, repeated chewing or stomach symptoms should also be disclosed to a clinician.

Does the hair pattern suggest pulling or another scalp condition? Could a behavioural therapist help me identify triggers? How should irritated skin be treated? What signs would show that hair follicles are being injured?