Trichotillomania, or compulsive hair pulling, is a Body Focused Repetitive Behavior (BFRB) in which the client feels an overwhelming urge to pull out the hair on their head, eyebrows, eyelashes or hair on the body. Trichotillomania is an impulse control disorder which affects women in a disproportionate number. The puller oftentimes reports being in a trance-like state while pulling, and can go hours without noticing that they are engaged in a pull session. Due to the damage that can be caused by excessive pulling of the hair, Trichotillomania is frequently accompanied by and exasperated by feelings of shame and embarrassment. The client might avoid social interactions and limit their lives due to their pulling and to the fear that others may notice and judge them, especially after a particularly bad 'session.' In severe cases, one might pull out most of the hair on their head or face. 


Signs and symptoms in Trichotillomania

·       Seemingly uncontrollable urge to pull out hair

·       Scanning throughout the day for areas where there is a ‘rogue’ hair

·       Pleasure, gratification or relief after pulling hairs

·       Using pulling as a reward or an indulgence after a bad day or after heightened anxiety

·       Pulling when bored or stressed

·       Others noting the pulling behavior when the puller is not aware

·       Thinned out eyebrows, hair or eyelashes


Treatment for Trichotillomania

Trichotillomania is treated using Cognitive Behavioral therapy (CBT) to challenge perfectionistic thought patterns, Mindfulness and Acceptance therapies to learn to tolerate the urge which often precedes a pull session, and Habit Reversal Training (HRT) to bring awareness to the behavior and provide alternate behaviors which are less damaging. Many people recover from trichotillomania and begin to develop more functional coping strategies for their pulling. Frequently, the pulling behavior is a coping strategy developed to deal with anxious thoughts, and in the course of treatment these anxious thoughts are also brought to the surface and examined. 

What is Habit Reversal Training (HRT)?

HRT is a behavioral strategy that combines a number of techniques to help reduce the damaging behaviors in Body Focused Repetitive Behaviors (BFRB's). HRT uses awareness training along with the use of an alternative behavior (substituting pulling for knitting for example) to gradually reverse the habit of pulling and skin picking. Awareness is the first step in changing any behavior, and by increasing awareness of all aspects that precede the pull/pick (triggers), including thoughts, sensations, urges, behaviors, and emotions, the client becomes better able to recognize that the pull/pick is about to occur. Eventually, rather than giving into the urge, the individual learns to engage in a competing response. A competing response (CR) can be any behavior which the individual engages in, such as squeezing a ball, drawing, meditating etc. to avoid feeding into the habit of pulling/picking. Because the habit of pulling and picking is strengthened every time the individual gives in, the competing response when used correctly, will weaken the urge and habit over time and eventually the individual will begin to feel more choice, awareness and freedom in relation to the behavior.