|The defining characteristic of Trichotillomania is the recurrent, compulsive pulling out of one's own hair, often resulting in observable hair loss. Usually, but not always, the scalp and/or face are the primary locations for hair pulling. While the most common hair pulling sites are the scalp, eyebrows, and eyelashes, Trichotillomania may involve any part of the body with hair. Less common locations for hair pulling include the pubic area, perirectal region, arms, chest, and legs. An individual with Trichotillomania may use his or her fingernails, as well as tweezers, pins or other mechanical devices. In severe cases, Trichotillomania can result in permanent hair loss or skin damage.
Often, but not always, Trichotillomania episodes are preceded by a high level of tension and a strong "urge". Likewise, hair pulling is usually, but not always, followed by a sensation of relief or pleasure. Hair pulling is usually done alone, often while watching TV, reading, talking on the phone, driving or while grooming in the bathroom. A Trichotillomania episode may be triggered by a negative mood state or occur in response to stress, but may also occur while an individual is calm and relaxed. Sometimes hair pulling is done as a conscious behavior, but it is frequently done as an unconscious habit. Recent reports indicate that approximately 10% of those with Trichotillomania also eat their hair after they pull it (Trichophagia). This can result in hairballs called bezoars, which can lead to severe gastrointestinal blockage.
Individuals with Trichotillomania often attempt to camouflage the hair loss that accompanies the disorder. Common camouflaging techniques include the use of hats, scarves, long-sleeve shirts, and false eyelashes. Some with Trichotillomania may even resort to having false eyebrows permanently tattooed. In extreme cases, individuals with Trichotillomania may avoid social situations in an effort to prevent others from seeing the hair loss that results from hair pulling.
As demonstrated above, Trichotillomania has obsessive-compulsive features that are quite similar to Obsessive-Compulsive Disorder (OCD), as well as Body Dysmorphic Disorder(BDD), and Dermatillomania, also known as Skin Picking Disorder. In fact, it is not unusual for an individual with Trichotillomania to also have features of OCD, BDD, and/or Skin Picking Disorder.
Treatment of Trichotillomania
The most effective treatment for Trichotillomania is a combination of various types of Cognitive-Behavioral Therapy (CBT). Perhaps the most important of these is called Habit Reversal Training (HRT). HRT is based on the principle that hair pulling is a conditioned response to specific situations
and events, and that the individual with Trichotillomania is frequently unaware of these triggers. HRT challenges Trichotillomania in a two-fold process. First, the individual with Trichotillomania learns how to become more consciously aware of situations and events that trigger hair-pulling episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.
Other Cognitive-Behavior Therapy techniques can be used as adjuncts to HRT in the treatment of Trichotillomania. Among these are Stimulus Control techniques and Cognitive Restructuring. Stimulus Control techniques involve utilizing specific physical items as "habit blockers" to restrict the ability to pull hair, while Cognitive Restructuring helps an individual with Trichotillomania learn to think differently in response to the urge to pull their hair.
One of the most effective CBT developments for the treatment of Trichotillomania is Mindfulness Based Cognitive Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem - our attempt to control and eliminate our discomfort is the problem. For those with Trichotillomania, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without pulling their hair. To learn more about Mindfulness Based CBT for the treatment of Trichotillomania, click here.
Individual Therapy for The Treatment of Trichotillomania
The OCD Center of Los Angeles offers individual therapy for the treatment of adults, children, and adolescents with Trichotillomania. Using the Cognitive Behavioral Therapy techniques outlined above, clients with Trichotillomania learn to respond differently to thoughts about their hair, and to resist the urge to pull their hair. We have eight therapists on staff, and our offices are open six days a week, including evenings and Saturdays. If you would like to discuss treatment options at the OCD Center of Los Angeles, please call one of our client coordinators at (310) 824-5200 (ext. 0), or click here to email us.
Group Therapy for The Treatment of Trichotillomania
In addition to individual therapy, the OCD Center of Los Angeles also offers five weekly, low-fee, therapy / support groups for adults with OCD and related conditions, including a group exclusively for adults with Trichotillomania and Dermatillomania. This group is led by one of our professional staff therapists, Elizabeth Kassel, MSW, and uses the same treatment protocol as our individual Cognitive-Behavioral Therapy program. Our weekly Trichotillomania / Dermatillomania group is held on Saturday afternoons, and is limited to eight (8) participants. For more information on this group, click here.
The OCD Center of Los Angeles also offers webcam based online therapy and telephone therapy to clients around the world suffering with Trichotillomania. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our office, and for those in remote areas who cannot find specialized Trichotillomania treatment close to their home. Telephone and internet therapy have repeatedly been found to be safe and effective in numerous research studies, and have been legal in California since 1997. If you would like to learn more about our phone and online therapy program for Trichotillomania, please click here.
Telephone and Online Therapy for the Treatment of Trichotillomania
Intensive Treatment for Trichotillomania
We also offer intensive Trichotillomania treatment for adults, adolescents, and children. This program is designed to meet the needs of those for whom standard outpatient Trichotillomania treatment is either unavailable or insufficient. Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about our intensive outpatient treatment for Trichotillomania, click here.
If you are experiencing any of the above symptoms of Trichotillomania and would like to discuss treatment or a consultation, please call one of our client coordinators at (310) 824-5200 (ext. 0), or click here to email us.
Please note that the above is not meant to replace a complete and thorough evaluation by a licensed Cognitive-Behavioral therapist or other qualified mental health professional. As with OCD, some individuals with Trichotillomania may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between Trichotillomania and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in the our area. Furthermore, it is imperative to make the distinction between Trichotillomania and other medical conditions. For this reason, a medical examination may be a necessary part of Trichotillomania treatment.