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It can mean more binding protein in circulation, vitamin released from injured cells, reduced clearance by the liver or kidneys, recent intake, or analytical interference, where the measured value does not accurately reflect the true B12 status

Hughto JM, Varma H, Babbs G, et al

Lateral gene transfer and parallel evolution in the history of glutathione biosynthesis genes (free full text)

Rarely, minor electrochemical burns if misused

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Nevertheless, it has been reported by some that when they do stop pulling, other emotions often rise to the surface since they are no longer numbed out due to the trance-like state that they experience when pulling their hair