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Mental Disorders

Treatment Recommendations for Trichotillomania (Hair-pulling) Disorder

Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C. E. Zupanick, Psy.D.

upset teen girlTreatment for trichotillomania is similar to the cognitive-behavioral techniques used to treat obsessive-compulsive disorder. However, some slight modifications are necessary:

  • Cognitive therapy for trichotillomania targets specific dysfunctional thoughts such as "I must tic/pull because I can't stand the urge," or "I'll just pull one hair and then stop."
  • Behavioral exposure and response prevention therapy for trichotillomania consists of intentional exposure to situations that increase the urge to pull. This is then followed by a deliberate effort to block or prevent the behavior. For example, people with trichotillomania frequently pull when engaged in an idle or boring activity such as watching TV. ERP would consist of them watching TV, but preventing hair pulling. This may be accomplished by mindful attention. Props may also be helpful in preventing the hair pulling response such as wearing oven mitts, or artificial nails. These props make it difficult to pull hair.
  • Habit reversal training (HRT, described below).

Although cognitive therapy, and exposure and response prevention therapy are a necessary component of treatment, another type of cognitive-behavioral therapy is called habit reversal training. This treatment strategy blocks or prevents the hair-pulling. HRT has several components including:

1. build an awareness of the behavior;
2. identify situations which increase the behavior;
3. develop relaxation strategies; and,
4. practice a "competing response." A competing response is one that makes it difficult or impossible to pull hair. Common, competing-response strategies for hair-pulling include: tensing the arm and hand muscles used in pulling; performing activities to keep the hands busy such as knitting; or the use of Band-aids®, or long, artificial nails which make it difficult to pull.