Trichotillomania

What is Trichotillomania?

Trichotillomania, sometimes called Trich or hair pulling disorder, is a mental health disorder characterized by recurrent, irresistible urges to pull out one’s own hair, possibly leading to noticeable hair loss and significant distress or impairment in social, occupational, or other areas of functioning. The hair pulling can occur from any part of the body where hair grows, such as the scalp, eyebrows, eyelashes, pubic area, beard, chest, or legs. The hair may be pulled and examined, chewed, bitten, or swallowed.

Trichotillomania affects individuals of all ages, although onset is most common in childhood or adolescence. The severity of trichotillomania can vary widely from person to person, ranging from occasional hair pulling to frequent, intense, and damaging episodes.

Some individuals with trichotillomania may be able to control their hair pulling or hide the hair loss, while others may experience significant functional impairment, shame, and social isolation. Trichotillomania can also cause physical complications, such as skin injuries, infections, or alopecia (permanent hair loss).

Dermatillomania

Dermatillomania, also known as skin picking disorder or excoriation disorder, is characterized by repetitive picking, scratching, or digging at one’s own skin, often to the point of causing injury or scarring.

Dermatillomania can lead to significant emotional distress and impairment in daily functioning, such as difficulties at school or work, social isolation, and decreased self-esteem. It can also result in physical complications such as infections, scarring, and disfigurement.

Stress, anxiety, boredom, and certain physical sensations may trigger skin picking behaviors in individuals with dermatillomania.

Evidence-Based Treatments

The most effective forms of psychotherapy for treating trichotillomania and dermatillomania: Cognitive Behavioral Therapy (CBT), Habit Reversal Training (HRT), and Dialectical Behavioral Therapy (DBT). Clinicians work with clients to identify and challenge negative thought patterns and behaviors that might help maintain the hair pulling while we concurrently teach individuals alternative behaviors.

These alternatives, also called “competing responses” may include relaxation techniques, self-distraction, or non-injurious ways of touching the hair or skin. During treatment we focus on better understanding when individuals are vulnerable to engaging in pulling behavior and to utilize skills for emotion regulation and distress tolerance.

At CBT Denver, we offer a combination of evidenced-based interventions that have been successful in reducing the frequency of skin picking. Habit reversal training (HRT) offers clients new coping strategies to manage their urges to pick their skin. We utilize principles of HRT in combination with other treatments such as Cognitive Behavior Therapy (CBT), Dialectical Behavioral Therapy (DBT), and mindfulness training, to help individuals increase awareness of skin picking behaviors and learn new skills to replace them with healthier alternatives.

What Treatment Looks Like at CBT Denver

CBT Denver clinicians all have advanced training in treating trichotillomania and dermatillomania. Treatments draw from evidence-based manuals using HRT and CBT but are also individualized to the clients particular situation. Treatment is generally 10-15 sessions and involves practicing strategies outside session. Clients who do “homework” get better faster and show greater improvement and symptom reduction.

Assessment

The first step in treating trichotillomania or dermatillomania is a thorough assessment by an expert practitioner to assess frequency and intensity of the skin picking or hairpulling, what situations trigger the pulling, what the client has tried, what has worked and what has not worked. An important part of the assessment is learning the function that the picking or pulling serves for the client. This can range from dealing with boredom, distracting from anxiety or other concerns.

Self-Monitoring

Self-monitoring is tracking of the context of the picking/pulling, intensity of urges, and the behaviors and emotions. This is key part of HRT and all CBT therapies. Self-monitoring draws clients attention to the behaviors they want to change, the feelings that arise around the behaviors. The act of tracking any behavior can actually change that behavior without any other intervention. When one becomes better at recognizing urges they are more effective in changing behavior.

Change Strategies

Change strategies include everything from managing triggers, learning competing behaviors, and many other tools.

Values and Goals

Discussion of values — what’s important to the client — and goals — what do they want to accomplish, is an important part of changing any behavior. When behavior change is tied to what’s important to the client in a larger sense - health, relationships, career success - treatment is more affective.

Learning to Tolerate Discomfort

A part of CBT for trichotillomania and dermatillomania, and CBT treatment for most concerns is learning to sit with and accept uncomfortable emotions, physical sensations, urges and physical sensations. Drawing from the “3rd wave” CBT therapies such as ACT and DBT can provide helpful ways to improve acceptance.

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