Mindset Family Therapy

Specialties | Trichotillomania Treatment

How common is hair pulling?

It was believed that this was a rare disorder, however recent studies show that it is actually more prevalent than previously thought. A study that was completed among college students shows that 1.5 percent of males and 3.4 percent of females had engaged in hair pulling that resulted in visible hair loss. Unfortunately, many individuals feel shame and embarrassment.  They hide the problem and don’t receive the help they need.  Hair pulling can affect individuals’ self-esteem and can also cause distress and serious social consequences.

This disorder was not well-known before the 1980s, though many hair pullers were struggling with it. However, studies and developments for OCD treatment caused the media to shed attention on this disorder. Many individuals began to believe they had a form of OCD because they were so obsessed with pulling their hair. There have been many studies since then and they provide hope for those suffering with this disorder. The DSM-V (Diagnostic and Statistical Manual of Mental Disorders) lists this disorder in the Obsessive Compulsive Disorder and related Disorders chapter. The Trichotillomania Learning Center, Inc. (TLC http://www.trich.org/) is dedicated to raising public awareness and to provide resources and guidance for sufferers and their families.

“Being happy doesn’t mean that everything is perfect. It means that you’ve decided to look beyond the imperfections.”


TTM is a chronic illness, but those being challenged can learn skills to manage it. Besides awareness of the action, individuals also need to become aware of their feelings, thoughts, and the situations that occur before and after pulling. Triggers are different for everyone.

Research thus far has shown that the most effective treatment for TTM and other body-focused repetitive behaviors such as tics, nail biting, and skin picking is behavioral therapy, including habit reversal training (HRT). This therapy was developed in the early 1970s by Drs. Nathan Azrin and Gregory Nunn.

There are four main components for habit reversal training: self-awareness training, self-relaxation training, diaphragmatic breathing, and competing response training. Because TTM is a complex disorder, most clinicians have discovered that besides implementing HRT they need to add CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), and ACT (Acceptance and Commitment Therapy) components for best treatment results.

Clinicians at the Behavior Therapy Center of Greater Washington have been doing extensive research for TTM treatment. They have presented their findings to various entities including the Trichotillomania Learning Center. They agree that HRT has been proven effective, but not reliable. A treatment that covers the behavioral, affective, and cognitive variables had been absent. For this reason, they developed the Comprehensive Behavioral (ComB) model to cover those missing areas.

Many clinicians working with individuals suffering from TTM and other body-focused repetitive behaviors believe the ComB model is a better option than HRT alone. It is a unique but effective alternative to what is being used in treating the disorder. It is a comprehensive approach and addresses the diverse elements of TTM. It also organizes information according to the individuals’ experiences and provides the opportunity to use a variety of therapeutic interventions.

“What you resist persists.”


Treating individuals with psychological conditions is not a “one size fits all” situation. At Mindset Family Therapy we use the evidence-based modalities that will help our clients. Treatment will be geared according to each client’s needs and challenges. We implement HRT, Cognitive Behavior Therapy, ACT (Acceptance & Commitment Therapy) and the ComB model.

The success of behavioral treatment depends on the client’s motivation to learn the skills, become aware of the urges, and consistently practice alternative responses. Stress can trigger hair pulling and/or increase the urge to pull or pick. Acceptance and Commitment Therapy that includes mindfulness training will be an essential component of your treatment.

Usually, individuals who are afflicted with this challenge don’t realize how bad it is until someone else points it out and suggests they seek help. Individuals who pull hair usually also have problems with picking their skin. Quite often, it is the physical appearance that’s bothersome. Others may seek treatment because they don’t like wasting so much time pulling or picking. Most of the time, clients’ self-esteem has been affected and they may also be experiencing anxiety and depression.

Treatment will be geared according to each client’s needs and challenges. Treatment will consist of awareness, learning competing responses, and modifying the behaviors of concern. During therapy, it is suggested that clients modify their environments in order to decrease hair pulling. Reinforcement strategies are used to help clients stay motivated with their work and continue progress. Cognitive strategies are taught so clients can understand that their thinking is affecting their behavior and feelings. Clients are invited to do written exercises to identify their negative thoughts and to restructure them.

Treatment is not easy. However, studies have shown that when individuals seek treatment, they achieve lasting progress when they have family members or friends who support them during treatment. Open communication between the therapist and clients is of utmost importance to be able to complete treatment successfully.

We will discuss relapse prevention and how clients may expect lapses (symptoms may increase temporarily) during treatment or even after treatment. However, they need to try not to be discouraged because lapses are bound to occur. What’s important is to remember the skills learned during treatment and to implement them daily.

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(801) 427-1054