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 considered a body-focused repetitive behavior (BFRB).  Other BFRBs include nail-biting and skin-picking.

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?

Fortunately, there are effective treatments for trich. The Comprehensive Behavioral Treatment (ComB) is the leading intervention for trich and addresses all aspects of the pulling behavior. 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.

ComB is a collaborative process between the client and the therapist.  After a detailed assessment, specific techniques are introduced in order to interrupt different parts of the pulling process.  These include behavioral, environmental, cognitive, and interpersonal strategies.  Progress is monitored over time and strategies are modified as needed.  ComB combines aspects of cognitive behavior therapy (CBT), habit reversal training (HRT), behavior therapy, and acceptance and commitment therapy (ACT).

Read more about ComB

My approach

When seeking help for trich, it is important to select a clinician that has specific training in its treatment.  Once thought to be solely a manifestation of anxiety, we now know that trich and other BFRBs are unique patterns of behavior that require directed intervention.  I’m trained in the ComB treatment method and regularly sees clients for the treatment of trich. 

In my experience working with trich, I’ve found that effective treatment requires creativity, consistency, and adaptability. The most successful clients are ready to commit to experimenting with strategies and allow me to hold them accountable regarding monitoring and interrupting pulling episodes. I frequently meet clients that have been pulling for years (or decades) and believe nothing will work for them. It is rewarding to see this belief slowly change as progress is made and sustained.

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. Click here to contact me directly.