What is Trichotillomania?
Trichotillomania is a condition involving pulling out hair from the scalp, eyebrows, eyelashes, or other places on the body. Hair pulling is similar to other Body-Focused Repetitive Behaviors (BFRBs), including skin picking and nail biting. The loss of hair due to hair pulling can lead to low self-esteem, feelings of shame, and difficulties with personal relationships.
Some people with trichotillomania report frustration that a seemingly voluntary action feels so “out of control.” They have been told by others to “just stop,” but find it is not so easy to stop and not resume the habit.
Who gets trichotillomania?
The problem is more common among women than men in adults. However, in adolescents the problem is equally likely to occur among boys or girls.
Is hair pulling a sign of big problems?
Some people suffering from BFRBs wonder if the problem means there is “something really wrong” with them. That is not the case.
Some people with BFRBs like hair pulling also suffer from problems with anxiety, but not all. Up to 13% of adults with trichotillomania suffer from an anxiety disorder or OCD, according to recent research.
As you will read below, the treatment for hair pulling and other BFRBs does not involve exploring childhood traumas or delving deep into the psyche to find some profound disturbance. Trichotillomania is understood to be something like a bad habit that has gotten out of control. It is not associated with serious emotional problems.
The trichotillomania treatment program at the Manhattan Center for CBT provides treatment for adults, adolescents and children. Treatment is provided by psychologists or externs specializing in BFRBs. The therapy for trichotillomania focuses more on the hair-pulling behavior happening now. it does not focus on the possible origin of the behavior, or even one’s feelings about the behavior.
Habit Reversal Training
CBT for BFRBs like hair pulling uses awareness training, stimulus control and competing response training. This type of behavior therapy is sometimes called habit reversal training (HRT), which was developed in the 1970s. HRT is quite effective for people with hair pulling, skin picking and other BFRBs.
These techniques teach strategies to tolerate urges to pull while using techniques that prevent pulling.
Does the Therapy Actually Work?
Yes. Scientific research has investigated what the most effective treatment is for trichotillomania. Most research has focused on three treatments: behavior therapy, a medication called clomipramine, and SSRIs (a group of medications). Generally, the research has found that behavior therapy is very effective. Clomipramine is also helpful, but not as helpful as behavior therapy. SSRIs (commonly prescribed medications like Prozac, Lexapro and Zoloft) are no more helpful than placebo for hair pulling.
Behavior therapy is considered very effective for hair pulling in the sense that 80% to 90% of people receiving it in studies showed improvement. In fact, of all the problems treated with behavior therapy, hair pulling often sees some of the best improvement.