Question: I am a teenage girl who bh has many things going for her; I have a great, loving family, plenty of friends, good grades and all in all I am very happy. I do suffer from trichotillomania (I pull out my hair). But just to make it clear those that don't know would not be able to tell, My friends know and really don't think it to it, it really has no effect on my life. Do you think it is necessary to go for therapy or do whatever it takes to stop (after all iyh I will get married and cover my hair anyway)?


 Trichotillomania (trich for short) refers to hair pulling and involves repeatedly pulling hair at one or more sites, such as scalp or eyebrows. People with trich often pull to the extent that they experience bald patches, which then often becomes a source of shame and embarrassment. In your situation, it doesn’t appear to be that intense so it is difficult to provide advice if you should go to therapy. I can provide some general guidelines, though, regarding therapy.

 The necessity of psychotherapy generally depends on the level of interference in our day-to-day lives as well as the level of distress combined with your desire to work on the problem at this time. If you decide to go for therapy, please keep in mind that this needs a specialized type of treatment as will be summarized below. As is true for other challenges (e.g., ADHD, OCD), general talk therapy is rarely helpful for stopping hair pulling. Effective treatment involves structured behavioral interventions as will be described below. Medication can be slightly helpful as an adjunct to this specialized behavior therapy.

 There is no general therapy for trich, rather it is directly related to the specific cause of the hair pulling. Hair pulling can stem from several different causes and each cause can result in a different type of treatment. Thus, the first step of treatment involves determining the function of the pulling for this person. The person is asked to monitor pulling and provide a summary of what happens before, after, and during the pulling. In addition, during the assessment other factors should be clarified such time day it happens, part of hair that is pulled, and instruments utilized. This will help clarify the warning signs that trigger the pulling including physical motor components (e.g., moving hand toward pulling site), and emotional factors (e.g., feeling stressed or nervous).

Emotional factors can be a common reason for hair pulling include relieving stress, ending boredom, and reducing anger and frustration. Studies have shown that hair-pullers report boredom, tension, or anxiety before these episodes and significant reduction in these negative emotions following pulling, suggesting the role of emotion regulation in pulling.  In addition, some may pull for sensory stimulation. They experience strong urges to pull when they notice certain types of hair, usually hairs that are different from the rest (e.g., thick, or wiry hairs). Others may do so to neutralize certain thoughts that occur just prior to pulling (e.g., I need to get rid of these white hairs). This specific understanding of what causes it will flow naturally into strategies for addressing the hair pulling and help the client and therapist develop a customized treatment plan.   

If specific emotions are causing the hair pulling, you can learn skills to regulate these emotions.  Example of dealing with stress include deep breathing, taking a relaxing walk, or distraction.  Other emotions such as boredom or pain can similarly be replaced with effective strategies. If the primary function is to feel sensory activation on the scalp, you can use find other ways to experience sensations such as brushes or even ice.                                                                                                                                                                                                                                                                                                  

Examples of problematic thoughts that may need to be targeted include incorrect beliefs about certain hair types (“gray hairs must go”) and justifications (I had a bad day so I deserve to pull). The therapist teaches the person to identify these thinking errors, appreciate their role in the trich problem, and develop more appropriate ways of thinking.

 Finally, if relevant based on the formulation, physical barriers can reduce hair pulling. Examples include throwing out tweezers, covering bathroom mirrors, and making pulling behavior more difficult to carry out by wearing gloves of putting on fake nails. Furthermore, changing the conditions of hair can help (e.g., placing Vaseline on eyebrows).