Trichotillomania is a chronic, often debilitating condition characterized by noncosmetic hair pulling which causes distress and interferes with daily functioning. Usually starting in adolescence, its intensity may fluctuate over time.
Treatment options may include behavioral and medication therapies. While herbs and supplements may also prove useful, their potential side effects should always be carefully considered before being added into treatment plans.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is one of the most successful treatments for trichotillomania. CBT aims at changing your false beliefs regarding hair pulling and teaching you how to control its symptoms effectively. The goal of CBT therapy is for patients and therapists alike to build an intimate and trustworthy bond, helping overcome this difficult condition together.
Trichotillomania is classified as a Body-Focused Repetitive Behavior (BFRB). Other examples of this type of behavior include compulsive skin picking, nail biting and tics - behaviors often brought on by stress or boredom which can cause great distress to individuals living their daily lives.
CBT can be effective in treating BFRBs, including habit reversal training and stimulus control techniques. As these strategies may help lessen the impact of symptoms, it is vital that you find an experienced therapist who understands these techniques and incorporates them into their treatment plans.
Habit Reversal Training (HRT)
HRT is a cognitive-behavioral treatment approach proven effective for treating trichotillomania and other body focused repetitive behaviors (BFRBs). It consists of four components: awareness training, competing response training, stimulus control techniques and relaxation techniques.
Habit reversal training involves learning how to recognize situations when pulling your hair is likely, and choosing another behavior instead - such as clenching fists or chewing gum. Your therapist can also offer strategies for changing any inaccurate beliefs you might hold about yourself or your behavior.
HRT should be offered as the initial treatment for trichotillomania and should be provided to anyone diagnosed. A trained clinician must administer this therapy, to ensure its efficacy. HRT has been well tolerated and numerous studies have demonstrated its positive outcomes; its use could potentially act as a frontline approach alongside medication to lessen symptoms associated with the disorder.
Acceptance and Commitment Therapy (ACT)
ACT is a mindfulness-based behavioral therapy approach that emphasizes accepting your thoughts and emotions as they arise and taking actions which reflect your values. Furthermore, ACT promotes being present in each moment as well as creating a strong sense of self that transcends internal emotions.
Contrasting CBT, ACT focuses on creating psychological flexibility (e.g., distress tolerance). Studies demonstrate its efficacy for various disorders including chronic pain and psychosis.
Studies have proven ACT to be an effective treatment for trichotillomania. One such comparison between ACT and habit reversal training (HRT) demonstrated similar outcomes when combined with behavioral commitment and relapse prevention strategies; specifically the latter component requires reviewing challenges that arise between sessions as well as planning new behavioral commitments to last until booster session number one; several studies have proven this approach can reduce hair pulling/picking as well as increase ability to tolerate distressful experiences.
Medications
Trichotillomania can have devastating repercussions. It can result in bald patches, hair thinning, depression and anxiety; unfortunately many with trichotillomania feel ashamed or embarrassed by their behaviors and fail to seek treatment for trichotillomania.
Medication may be useful in treating trichotillomania when other behavioral therapies fail, especially if other SSRIs and naltrexone haven't shown success. Studies have also demonstrated the usefulness of neuroleptics such as Olanzapine (Zyprexa) and Risperdal in some patients suffering from both trichotillomania and skin picking.
Memantine, an Alzheimer's drug that affects glutamate, has also proven useful. Memantine can improve symptoms associated with trichotillomania and skin picking; to use this effectively it must be prescribed by a mental health provider with experience providing behavior therapy treatments and being licensed to prescribe medications for these conditions.