What is trichotillomania?
Trichotillomania, also known as hair pulling, is the repetitive pulling of one’s own hair. Trichotillomania is one of a group of behaviors known as body-focused repetitive behaviors (BFRBs). Many people feel compelled to pull the hair on their scalp, but others may pull their eyelashes, beards, or eyebrows.
Symptoms of trichotillomania include:
- repetitive pulling of the hair, often without any awareness
- a sense of relief after pulling out hair
- inability to stop hair pulling, despite repeated attempts to stop
- anxiety and stress related to hair pulling
- a need to perform other repetitive activities related to the hair (e.g., counting or twisting hairs)
- Trichophagia- biting, chewing or eating of pulled hair
- playing with pulled-out hair or rubbing it across your lips or face
- skin irritation or tingling at affected sites
- noticeable hair loss or bald patches due to hair pulling
BFRBs also include such behaviors as skin picking and nail-biting, which can result in damage to the body. Hair pulling, skin picking, and nail-biting can also negatively affect your self-esteem and how you feel about yourself.
Those who struggle with trichotillomania often feel shame and embarrassment. This may lead you to feeling anxious and depressed because you are not living the life you want to live.
You’re afraid to go out because others may judge you. You worry that they’ll notice, that they’ll say something or worse… whisper among themselves.
As a result, you isolate yourself and hide from family and friends. You don’t really need other people to judge you because you judge yourself. Your life revolves around your episodes of pulling and picking.
Even when you are not in an active episode, pulling and picking behaviors affect how you think about and plan your day.
You wonder, “can I wear a hat there?”
“What if someone asks me why I don’t have lashes?”
“Will they notice my arm/fingers are bandaged?”
Is relief from hair pulling and skin picking possible?
Some days or weeks you feel good because you haven’t pulled or picked, and you see some progress in hair or nail growth. Then you catch yourself pulling again and feel defeated. You tell yourself that you’ve failed.
Days and weeks of progress: gone. You are angry at yourself and feel like you let yourself down. It feels like you are on an emotional roller coaster.
I want you to know that together, we can treat this. We will uncover what triggers your episodes of hair-pulling and/or skin picking, and we will design a plan that will help you to feel in control of yourself.
What causes trichotillomania?
While trichotillomania affects anywhere between 0.5 and 2% of the population, the cause is still unclear. What is known is that those who struggle with trichotillomania often suffer from anxiety and/or depression. It is also not uncommon to develop symptoms of obsessive-compulsive disorder.
Some have reported that pulling or picking provides them with temporary relief from stress or emotional pain. Others have shared that they pull their hair when bored.
Researchers have also found that trichotillomania is more common in those who have a family history of the disorder as well as those who have experienced childhood trauma.
While the cause of trichotillomania and other BFRBs is unclear, the good news is that we know how to treat trichotillomania effectively.
What does treatment for trichotillomania look like?
Treatment is tailored to you. I use the two approaches with the strongest research support for hair pulling, skin picking, and other body-focused repetitive behaviors (BFRBs): Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB). I have a certificate from the Trichotillomania Learning Center (now the TLC Foundation for BFRBs) in treating BFRBs.
Habit Reversal Training (HRT)
HRT is a specialized form of cognitive-behavioral therapy. It has three main parts:
- Awareness training: many people pull or pick without noticing. You’ll learn to recognize the moments, places, feelings and early warning signs that come before an episode.
- Competing responses: you’ll practice a simple, discreet action that makes pulling or picking harder in the moment, such as clenching your hands or holding an object, until the urge passes.
- Support: we’ll identify how the people around you can help, without judgment or nagging.
The Comprehensive Behavioral Model (ComB)
ComB builds on HRT by looking at everything that keeps the behavior going. Together, we’ll explore five areas:
- Sensory: what the pulling or picking feels like, and what sensation you are seeking
- Cognitive: the thoughts that come before or during an episode, like “just one more” or “it has to be even”
- Affective: the emotions involved, such as boredom, stress, anxiety, or frustration
- Motor: the habits and hand positions that make pulling or picking easier
- Place: the settings where it happens most, like the bathroom mirror, the car, or your desk
From there, we build a personal plan with strategies that fit your specific triggers. Along the way, you’ll also learn self-monitoring, relaxation, and mindfulness skills. There is no magic wand or magic pill. But with effective treatment, hair pulling and skin picking can be greatly reduced and even stopped. It may not be easy, and I’ll support you every step of the way.
Begin therapy for hair pulling and skin picking in Ridgewood, New Jersey
You don’t have to live with the overwhelm and stress of trichotillomania or other body-focused repetitive behaviors. Therapy can help you feel more confident and in better control. In my Ridgewood, New Jersey, counseling office you will meet with a skilled therapist who specializes in the treatment of trichotillomania and related disorders.
I am Dr. Maria Staropoli-Hafner, and I can help you overcome the shame and frustration you’ve been feeling. Click the button below to schedule your free consultation and begin your treatment for trichotillomania today!
Our Ridgewood, NJ location is convenient for clients from across Bergen County, including Glen Rock, Ho-Ho-Kus, Wyckoff, Midland Park, Waldwick, Paramus, Fair Lawn, Saddle River, and Franklin Lakes. I also offer secure virtual therapy anywhere in New Jersey and, through PSYPACT, in many other states, so college students away at school can continue care with me.