Trichotillomania (also known as trich or “hair pulling disorder”) is a disorder characterized by habitual hair pulling (pulling can take place at the scalp, eyelids, eyebrows, or pubic areas). It is a part of a group of disorders known as Body Focused Repetitive Behaviors (BFRB). Skin picking disorder (excoriation) and nail biting disorder (onychophagia) are also common BFRBs. Trich affects around one out of every 50 individuals, and generally has an onset of late childhood or early adolescence (around ages 11-15). For many people, especially children, hair pulling can be a mindless activity, with little to no memory of the behavior. However, some people pull out specific hair, whether it is due to color, placement, or other factors. Some individuals with trich are also compelled to eat their hair, which can cause other problems as well.
The effects of trichotillomania can range from mild to severe. If trichotillomania is left untreated, it can become a much more physically and psychologically damaging disorder. Health problems such as permanent hair loss, repetitive motion injuries, skin infections, and intestinal problems can arise (for those who ingest their hair). Trichotillomania can be chronic and reappear throughout the lifetime, no matter how long an individual has been in remission. Many affected individuals are embarrassed about their appearances, causing them to avoid social interactions in which their disorder may be discovered. For children, trich can have an especially harmful social impact. Many children attempt to hide their hair pulling, but the changes in appearance can harm self-esteem, and can impact social life and school performance. However, successful treatment is possible.
The most important factor contributing to successful treatment is early intervention and finding a provider who offers evidence-based practices. Cognitive Behavioral Therapy (CBT) is the leading treatment for trich, sometimes accompanied or preceded by medication. CBT focuses on the thoughts, beliefs, and behaviors that are problematic and teaches individuals how to change these factors to reduce stress and anxiety, and behaviors of hair-pulling.
One of the most evidence-based CBT approaches to treating trichotillomania is habit reversal training (HRT). HRT can be successfully utilized to treat hair-pulling disorders such as Trich in both children and adults. Developed but Nathan Azrin and Gregory Nunn in the 1970s, HRT is a multi-component therapy that is essential to short-term treatment. The three most important factors in are awareness training, competing response training, and social support. It is important to seek services through a clinician who has received specific training in treating hair-pulling disorders, and can provide a thorough overview of treatment to parents and children.
Children who suffer from trich can be treated with the same evidence-based CBT and Habit Reversal Therapy (HRT) approaches as adults. It is important that parents are involved in the treatment of the affected child, in young children, this is especially the case. Parents are responsible for overseeing all treatment, both at home and with the therapist. In school-age kids, it is important to involve the child, and to develop a reward system that will motivate them to stop the unwanted behavior. In adolescence, the role of the parent shifts greatly as their children become more independent.
Trichotillomania affects an individual on multiple levels, physically, mentally, and socially. Especially in children, trich can involve the entire family, but there is hope. It is important to seek help from a qualified and trained therapist in order to receive effective treatment.
At GroundWork Counseling in Maitland, two of our therapists have received specific training for the treatment of hair pulling disorders and other BFRBs through the IOCDF BTTI institute and provide treatment to both children and adults.