Understanding Trichotillomania

Written by Andrea Potthoff PhD LP
What is trichotillomania?
Trichotillomania (Hair-Pulling Disorder) is characterized by excessive pulling of one’s hair. This can occur anywhere on the body, including hair on the scalp, eyelashes, eyebrows, facial hair, and body hair. Trich is seen more commonly in women, but also occurs in men. Trich occurs in all age groups and is most common in adolescence and early adulthood.
Many people describe the actual act of pulling the hair as very ritualized. They may only do it during certain activities or times of day. Patients also often report being very selective about which hairs they pull, noting that they pull hairs that “don’t feel right” or have a coarser or brittler texture.
It is also common among those that pull hair to ingest the hair they have pulled. This behavior can produce a high degree of shame and embarrassment. Unfortunately, this can also cause a number of medical problems depending on the frequency and amount.
What causes it?
Research suggests a genetic predisposition for trich and it is more common in people with a family history of obsessive-compulsive disorder (OCD). Often times it develops as an anxious coping behavior that then turns into a habit. Sometimes the pulling can be intentional and systematic and other times it can happen with little awareness. Many people find that the habit starts infrequently, but then becomes difficult to stop.
How is it treated?
Many people with trich report that the more they try to resist pulling, the more intense the urge becomes. When others comment on the behavior or notice the loss of hair, this can be an intensely shameful experience. Similarly, children scolded for the behavior continue to pull their hair. Although individuals are motivated to stop pulling, specific tools are needed in order to change the behavior. Reducing shame and guilt about the behavior is often the first step of treatment.
Fortunately, there are effective therapies for trich. The Comprehensive Behavioral Treatment (ComB) is the leading intervention for trich and addresses all aspects of the pulling behavior. There are four phases in ComB that include assessing the frequency and intensity of the pulling, determining causes and reinforcers of the behavior, determining what modalities to target, teaching strategies to reduce or eliminate the hair-pulling, and evaluating and modifying each strategy as needed. When working with children or adolescents, treatment also involves working with parents and caregivers. ComB is an evidence-based treatment, meaning that research has shown it to be effective in the treatment of trich.
Medication is also a treatment option for trich, although current research suggests that behavior therapy is more effective and the FDA has not approved any medication for the specific treatment of trich. It is important to also keep in mind that some medications may increase the frequency of hair-pulling.
If you would like more information about trich or to schedule an appointment please call us at 612-470-4099 or email us at andrea@dendrinospsychology.com.