Trichotillomania (TTM; Hair Pulling Disorder) is estimated to affect between 1 to 3% of the general population. Unfortunately, it is often an underdiagnosed and mistreated disorder.
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What To Expect.
Cognitive-Behavioral Treatment (CBT)
Individuals will be engaged in a 12+ week program using cognitive behavioral therapy. Researchers and practitioners agree that the use of CBT in treatment for trichotillomania is recommended. CBT for this disorder has traditionally consisted of habit reversal training (HRT) which includes using the comprehensive behavioral model. HRT’s treatment package designed to treat motor habits. It includes the following:
- habit awareness training
- incompatible response training with implementation of an action (such as fist-clenching) that is incompatible with the hair pulling response
- relaxation techniques
- social support
Stimulus control procedures targeted at reducing stimuli or situations that trigger hair pulling, cueing the individual when engaging in the behavior, and/or providing substitutes for sensory reinforcement are also often used to treat TTM.
Other treatments that have shown effectiveness is Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). When paired with HRT and comB individuals can have wonderful success.
TTM can start at any age though the mean age of onset is in early adolescence between 11-13 years old. Research findings indicate that TTM more often affects women than men. In clinical settings, the female to male ratio of occurrence is 9:1 or higher. This is possibly due to hormonal changes in women than men.
What Is Trichotillomania?
Trichotillomania is characterized by repeated pulling of one’s hair for non-cosmetic reasons from any body area, most often the scalp, eyelashes, eyebrows, beard, or pubic area. Individuals who pull can report an urge prior to, or when attempting to resist, pulling. They often also report pleasure, relief or gratification after pulling. An individual may pull hair from single or multiple sites. The pulling site(s) may change over time. Pullers can use their hands or instruments to extract hair.
Many people describe not being aware of their pulling behavior while it occurs. This style of pulling has been termed "automatic pulling". This can happen when a person is engaged in tasks or engrossed in thought, such as while watching television, talking on the phone, reading or lying in bed.
Another style of pulling is "focused pulling". This is often associated with thoughts of pulling or a compulsion to pull that may be in response to a negative emotional state, physical sensations or an intense urge.
Trichotillomania is currently listed in the Obsessive-Compulsive and Related Disorders Section of the 5th edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5). It also shares features with obsessive-compulsive disorder and other obsessive-compulsive spectrum disorders (such as Tourette Syndrome, Body Dysmorphic Disorder, and pathologic skin picking). Some refer to TTM as an OCD spectrum disorder; others categorize it as a body-focused repetitive disorder (BFRB) or grooming disorder.
The current DSM-5 (APA, 2013) diagnostic criteria for TTM include:
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- Recurrent pulling out of one's hair, resulting in hair loss.
- Repeated attempts to decrease or stop hair pulling.
- The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition).
- The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder).