Trichotillomania | The Habit of Pulling Your Hair

Published on: 09/10/2020

If you’re at your wits’ end trying to leave your hair alone, ask your doctor if you have hair-pulling disorder.

You may already have a bald patch on your head and feel anxious about it because you can’t control yourself from pulling hair. Or probably, you’re not even aware that you’re doing it. Instead of chalking it up as a bad habit, don't hesitate to talk to a medical professional. 

Having a compulsive need to pull hair out signals an impulsive control disorder, also called trichotillomania. However, research on this is still limited. There’s a suggestion that it’s a means of escaping from stressful situations or unpleasant experiences. Boredom, sadness, or anger may be another reason why some people pull their hair out. And the scalp is not the only pulling site. The eyebrows, eyelashes, pubic hair, and other hair-bearing spots are also at risk.

There may be drugs that can help with the treatment or control some symptoms of trichotillomania, but studies on medication are also lacking. Behavioral therapy is considered the best way to deal with it.


1. Habit Reversal Training (HRT)

This therapy is the first treatment for trichotillomania with most empirical evidence. It involves awareness training and stimulus control, which can help a patient identify triggers and minimize the influence on the behavior. It also includes competing for response training that encourages replacing picking with another action.

Another component is the training of social support. In an article published in Psychology Research and Behavior Management, this approach aims to train a support person to reinforce the competing responses and point out to the patient the "warning signs" without discouraging them.  


2. Comprehensive Behavioral Model (ComB)

This treatment model, pioneered by Dr. Charles Mansueto, et al., acknowledges the diverse factors that encourage pulling. It provides the patient and therapist with a framework for decision-making, such as what strategies to employ and what aspects need to be revised or refined.

There are four phases in this model. First, clinicians assess why the patient pulls his hair. Second, they identify and target potential types of pulling hair (i.e., cognitive, affective, motoric, sensory, and environmental). Third, they identify and choose treatment strategies, including Hormonal Replacement Therapy, emotional regulation, and environmental interventions. Lastly, they evaluate and modify.  


3. Acceptance and Commitment Therapy (ACT)

Steven Hayes and Kirk Strosahl developed this empirically supported approach to psychotherapy. This therapeutic process helps clients to accept difficulties, choose to behave based on their motivating values and act for their goals despite of unpleasant emotions or psychological associations.

Mindfulness, which can be defined as paying close attention to what you’re experiencing at the present moment, is one feature of ACT. According to a study published in the Journal of the Belgian Association for Psychological Science, mindfulness training might be an effective intervention for trichotillomania.


You’re Not Alone

Treatment for trichotillomania is a complex process and may take a long time because there’s often a tendency to relapse. What works for one person may not be effective for others. Some interventions may also lose their efficacy over time. It will take monitoring and commitment to see results.

If you can’t fight the incessant urge and temptation to pull your hair by sheer determination, seek the help of a specialist. There is no shame in asking for help.