An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing, due to appearance and negative attention they may receive. Some people with trichotillomania wear hats, wigs, false eyelashes, use makeup such as an eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as "pulling") whatsoever, and this "pulling" often resumes upon leaving this environment. Some individuals with trichotillomania may feel isolated, as if they are the only person with this problem, due to low rates of reporting.
an additIONaL PsychoLOgICaL effECt caN be low self-Esteem, ofTen AsSociAteD with being ShunnEd BY peeRs anD tHe fEar oF socIAlizIng, dUE to aPPeArancE And nEGative ATTEntion THeY May RecEive. sOme pEoplE wiTh tRIcHotilloManIa weaR HATs, wigS, FaLsE EyelashES, uSe maKeUP Such as an EYebrow PeNcIl, or sTyLe thEir haiR iN an eFfoRt tO avoID such AtTentiOn. there sEEMs to be a strOng stress-rElated componeNt. iN Low-StREss envirONMents, some eXHibIt NO sYmPToms (kNOWn as "PuLling") whatsoEver, anD this "pUlLing" ofteN reSUmes uPoN lEaviNg This eNviRoNmEnT. SoME iNDiviDuAls wiTh tRichotILLomania maY fEel IsolAted, AS If thEy Are tHE only PerSon WiTH tHis pRoblEm, dUE TO lOw Rates Of rEPorTIng.