TRICHOTILLOMANIA - SYMPTOMS AND TREATMENT

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.

Usually, 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 OCD, BDD, and Dermatillomania (compulsive skin picking, or CSP). The primary treatment modality for Trichotillomania is a type of CBT 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.

There are a number of other therapeutic techniques that can be used as adjuncts to HRT. Among these are Stimulus Control techniques and Exposure and Response Prevention (ERP). Stimulus Control techniques involve utilizing specific physical items as "habit blockers" to restrict the ability to pull hair. ERP, which is the primary treatment for OCD and many OC Spectrum disorders, is most valuable if the individual with Trichotillomania is already aware of the specific situations and events that trigger hair-pulling episodes, and has already made significant recovery using HRT. To learn more Cognitive Behavioral Therapy, click here. Also, medications that are frequently used to treat OCD may be valuable adjuncts to CBT in the treatment of Trichotillomania.

In addition to individual therapy for Trichotillomania, the OCD Center of Los Angeles also offers five weekly, low-fee, therapy/support groups for people with OCD and related conditions, including a group exclusively for adult women with Trichotillomania and Dermatillomania. This group is led by one of our staff therapists, and uses the same treatment protocol as our individual Cognitive-Behavioral Therapy program. For more information on this group, click here.

If you are experiencing any of the above Trichotillomania symptoms, and would like to discuss individual or group therapy for the treatment of Trichotillomania at the OCD Center of Los Angeles, you can call us at (310) 335-5443, or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.