Tips for dealing with Trichotillomania
I have had Trich since age 11, I'm now 23 and I've learned a lot over the years. One thing I will say is that not everyone will respond to certain treatments/medicine the same way. This is why Trich is so difficult to treat and is keeping doctors puzzled to this day.

First off, I will say that I have found a medicine that works really well for me! It's called Naltrexone.
I take it in a low dose, and it works by blocking the opioid receptors in the brain that cause "pleasure signals"...aka when you pull and it feels good and addicting.
Naltrexone is thought to work especially for those with Trich who pull because they like the feeling. Not to say it can't work for those who do it from anxiety and whatnot, because I have that too. And we all know that once you pull long enough, our brains are wrongly wired to get pleasure from it.
** Other options for treatment you may not have tried are the N-AC supplement, and Inositol (a vitamin B) powder in high doses.
N-AC stands for N-AcetylCysteine.
Note that Inositol must be taken in the powder form (you can get large bottles of it online) because otherwise you'd need to take TONS of the pills per day.
Read more on treatment options at BFRB dot com (this is the site for all picking/pulling disorders)

Tips to stop pulling

1. When in an area that you tend to pull the most (usually the couch, in bed, favorite relaxation spot at home) keep hats nearby. I mean literally within arms reach. I keep a hat in my bedside drawer, under my pillow, in the cushion of the couch. We have to be strategic in fighting this. When we get into our pulling trances, oftentimes it's nearly impossible to break free for long enough to physically get up and grab a hat. You could also try putting a note posted on the wall saying "STOP" in the area you tend to stare at when you get in a pull trance.
2. CHANGE YOUR ROUTINES. At home this is a big one. Don't go and sit down in the same spot you do every day that you always end up pulling at. Try keeping yourself busy with multiple sensory stimulations at once. For example, instead of cleaning your room in silence (which leads to pulling) play music, a podcast or audiobook.
If it's time to watch your tv show, put a hat on, and grab a fidget toy or put on a pair of gloves BEFORE sitting down. We can't always get out of the cycle once we fall into it, but giving yourself obstacles is a great start.
3. Try using the nail polish that tastes bitter. It's used to help stop biting nails, but as most tricksters do, I put my hands to my mouth when biting off the follicle. The taste may deter you.
4. If your balding is getting bad, try consulting a trusted hairdresser to figure out your options. I KNOW this one is SO hard to do. It's embarrassing to show others your hair. Thankfully, I have a hairdresser who actually has Trich herself, and she works in a salon that's totally sectioned off from other people so I don't have to worry about others watching. I opted to get a specialized sew in extensions (weave). This method is very pricy, I spend $360 every 8-9 weeks to get it re-done. Plus the occasional cost of purchasing new hair. My extensions are sewn in to the back crown of my head, and prevents me from pulling in that area it covers. My hair in that trouble spot has grown about an inch per month since doing this! However, the downside is that you have to strongly combat pulling in the areas that are left....I've thinned the front of my hair quite a bit. But overall I'd say it's worth it. Plus I don't have to stress about having bald spots...the hair extensions cover everything. It's also a HUGE confidence boost to have thick beautiful hair!

5. Try going to Sally's beauty store (or a place like it) and picking up a bottle of root cover up spray. It's about $5 and it's essentially temporary hair color in a can. I spray this directly to my scalp in places that are a bit thin. They come in brown, black, blonde, and red colors at the store I go to. There's positives and negatives to this...
Pros: your spots are covered. When you go to pull, you often get color transfer on your hands, for me this is often a visual reminder that I'm pulling and shouldn't be, and I'll often stop....Buuuuuuttt....
Cons: if you have little self control, you can be left with the temporary color all over your hands, under fingernails, and on your lips if you keep pulling. It also can drip occasionally with sweat if you spray it too close to the front of your scalp. I typically use it for the middle/sides of the crown, and it works great. It also will even stay after washing your hair if you don't scrub your scalp excessively in the shower.

6. Play with silly putty, sculpting clay, make jewelry, knit, paint, sew, draw, keep your hands busy at ALL COSTS! Jewlery making for me is especially good because I just love focusing in on tiny little things and making them perfect. I truly believe Trich is linked to some sort of perfectionism based OCD/anxiety.

7. Chew sugar free gum when sitting around. Your less likely to pull and feel the urge to put your hair follicle in your mouth.

8. DRINK LOTS OF WATER! Seriously, this sounds stupid, but I keep one of those offbrand Yeti cups filled with ice water with me all the time, and whenever I get the urge, taking a drink of water can help. Keep yourself hydrated and you will find that you are more clear minded and less likely to zone out.

And lastly, try prayer!!! What have you got to lose by reaching out to God and asking for his help? If your not a believing person, that's okay, but if you do believe in God, why not try it!
Daily time spent reading the Bible, devotions, and prayer are beneficial just as meditation is! Everyone knows we need a calming activity in our daily routine.

Keep fighting, never give up! One day there will be answers, and people will better understand our struggle. Until then, never stop searching for what works for you. I promise you, it's the best thing you can do for yourself.