Many people with trichotillomania try to stop the behavior but feel unable to do so. This sense of being unable to avoid performing a particular behavior is very similar to the compulsions in obsessive-compulsive disorder (OCD). Like OCD, the desire to pull hair is frequently described as a compelling urge that is often preceded by a strong emotion. At times, these behaviors are consciously and intentionally performed as a means of coping with powerful or painful emotions. However, unlike OCD compulsions, people with hair-pulling disorder report a pleasurable gratification from hair pulling.
Another difference between OCD and hair pulling is the hair pulling may not be preceded by an obsession or intrusive thought. The same is true of skin-picking disorder (excoriation). This distinction has led some professionals to suggest that perhaps hair-pulling and skin picking are more similar to each other, than to OCD. Subsequently, some mental health researchers and clinicians believe that hair-pulling and skin-picking, belong in a separate category of body-focused, repetitive, behavioral disorders. People with this disorder often have other body-focused repetitive behaviors such as nail-biting, and skin-picking (excoriation disorder).