Trichotillomania

TRICHOTILLOMANIA

COMPULSIVE HAIR-PULLING

Those with Trichotillomania (TTM), commonly referred to as “Tric” pull their hair compulsively. Specifically, they often pull from their scalp, eyebrows and lashes, though they also pull from other area of the body. People with TTM will sometimes pull other’s hair or the the hair of pets. The pulling leads to hair loss and goes on despite efforts to stop. While some assume this hair-pulling is a form of self-harm, most who pull find it to be pleasant and soothing. Indeed, people with TTM enjoy pulling, and it often takes on an addictive quality for them. People often pull to manage emotions and to achieve or avoid certain sensory experiences. The habit is also triggered by associations with certain postures and environments.

TREATMENT FOR TRICHOTILLOMANIA

There are a few go-to treatments for those with Body-Focused Repetitive Behaviors (BFRBs). One is Habit Reversal Training (HRT). This therapy supports people’s awareness of pulling through logging. Treatment also involves competing response training, in which a person tenses their muscles in a way that is incompatible with pulling for one minute whenever the urge to pull arises. HRT also includes relaxation techniques, like diaphragmatic breathing.

More recent models of HRT, often called HRT Plus, have included Stimulus Control (SC) as part of the approach. SC refers to the fact that certain factors can trigger behaviors. To interrupt these factors, HRT Plus uses techniques, like the use of habit blockers (things that prevent the behavior, like bandaids or hats), stimulation replacements (like fidget toys), and environmental changes to support reduced pulling.

Treatment for TTM also includes a Comprehensive Behavioral (ComB) Model of Treatment. With ComB, individuals track pulling and also note what triggered their pulling. Triggers are organized into five categories: Sensory, Cognitive, Affective, Motor and Place Domains. ComB uses the acronym SCAMP to help people remember these five domains. By noting what precedes pulling, a person can be better prepared for future triggers.