What is Trichotillomania (Hair Pulling Disorder)?
Trichotillomania, also known as hair pulling disorder or “trich”, is a disorder involving the repetitive pulling out of one’s own hair, despite multiple attempts to stop or decrease the behavior. It is conceptualized to belong to a collection of behaviors known as body focused repetitive behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in unwanted damage to the body.
Although the severity of hair pulling varies, many individuals with trichotillomania exhibit noticeable hair loss, which they attempt to camouflage. Physical effects of pulling such as pruritus, tissue damage, infection, and repetitive motion injuries to the muscles or joints are not uncommon. Those who ingest pulled hair or parts thereof have the potential to experience gastrointestinal distress or develop a trichobezoar (hair ball in the intestines or stomach), which could lead to gastrointestinal blockage and require surgical removal. Although trichobezoars are rare, they are a serious risk for those who ingest hair.
Individuals who struggle with trichotillomania may experience shame and embarrassment, and as a result, may avoid certain social situations or activities (e.g., outdoor activities, wind, pools, gyms, beaches, physical intimacy), salons, and medical care. The emotional impact of the disorder can lead to painful isolation and emotional distress, placing them at risk for co-occurring mood or anxiety disorders.
Treatment for Trichotillomania
CEH provides evidence-based treatment for trichotillomania and other BFRBs including individually-tailored cognitive behavioral therapies (CBT), namely habit reversal training (HRT) and comprehensive behavioral model (ComB) intervention. Behavioral therapies, HRT and ComB both involve psychoeducation, awareness training, behavior analysis, and behavioral intervention strategies. In HRT, interventions are primarily based upon modifying antecedents and consequences, including stimulus control (modifying the environment to decrease the likelihood of pulling urges and behaviors) and competing response training (responding to pulling urges with substitution behaviors that are incompatible with pulling).
ComB interventions may include a wider range of cognitive, behavioral, and other evidence-based interventions aimed at the most relevant aspects (sensory, cognitive, affective, motoric, place/environmental) of the individual’s behavior analysis. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) skills training may also be among these interventions, which have been demonstrated to be effective adjuncts to such behavioral interventions. Family involvement in treatment may also be included to assist loved ones in learning how to best support their family member.
In addition to treatment, CEH provides free, monthly community support groups for those whose lives are impacted by trichotillomania and other BFRBs.