Trichotillomania: Start your healing with these 3 essential steps

By: Suzanne Feinstein, PhD

Do you or does someone close to you struggle with a hair pulling disorder? Are you at a loss for what to do about this stubborn problem? You may have questions about what causes the disorder, if it ever goes away, and how to best cope with it.  

There are several inaccurate sources online that talk about trichotillomania as an untreatable illness.  Unfortunately, people’s repeated failures in therapy are partially to blame for this pessimistic outlook.  Mental health professionals attempt to treat this problem without any proper training, resulting in the less than promising success rates.  The purpose of this article is to offer you an inside view into how effective therapy works for trichotillomania and related disorders.  And it’s to assure you that the proper therapy really does work.

Habit Reversal Therapy (HRT) is a specific type of Cognitive Behavior Therapy (CBT) for trichotillomania which aims to stop this unwanted behavior by using action-oriented, time-limited and practical approaches.  There is no one-size-fits-all method to treating trichotillomania. The therapy experience remains unique to every individual.  Each treatment plan targets a different array of symptoms, different levels of motivation and different obstacles for recovery. 

That said, HRT takes into account the considerable overlap that exists among people with Body Focused Repetitive Behaviors (BFRBs). It helps to increase awareness of the behavior, create barriers to make the behavior more difficult, promote healthier coping strategies, and reduce any associated shame that accompanies the habit. 

The following guide demonstrates three much needed steps towards starting treatment and ultimately breaking your hair pulling habit.

Step 1: Ask for help

  • Admit to yourself you are struggling 
  • Stop the self-judgment 
  • Ask for help 

A hair pulling trance shields you from unpleasant emotions and responsibilities. This disorder effectively lulls you into a reinforcing state of denial, making it extra difficult to break free of the behavior.

It can be difficult to admit to yourself that you have this problem. Once you step out of denial, it can be even more difficult to admit to someone else that you need help. It is important to stop the negative self-talk in order to pursue positive actions. Asking for help shows courage and responsibility. 

Keep in mind that the time you spend putting off treatment is likely much more than the time needed in treatment to rid yourself of this problem.  

Are you a parent of a child who has been picking and pulling?  If so, you may have put off seeking treatment for months or years with the hope that this is just a phase that your child will outgrow. You may be seeking out advice from pediatricians, the internet, friends, and teachers but are generally unsuccessful at getting your child to stop picking. When you realize that bribery, punishment and ignoring the problem don’t work, hopefully you will reach out for help.  

Step 2: Stop the excuses

Do you tell yourself….?

  • I can stop on my own
  • I can’t be helped
  • I shouldn’t need to seek help for a problem I am bringing on myself

If you had a broken arm, you’d go to a doctor to get it X-rayed.  You’d wear the cast, reset the bone and not make excuses for why you don’t help yourself. Treating this problem is no different.

These anxieties and disruptive dialogues can certainly delay your request for help. You are not alone in these fears. Keep in mind a skilled mental health professional is there to help, not to judge. 

So what’s it going to take for you to feel truly ready to start treatment?  Readiness may come after a “binge” of pulling or picking.  The damage may have to be bad enough that you can’t hide the scars, bald spots or red marks you’ve made.  Or maybe you won’t seek treatment until a family member or friend comments on your thinning hair, scarred skin or hair twirling. You may put off treatment until you develop a medical complication like a skin infection from digging under your skin for a hair, dental problems from chewing your hair, or gastrointestinal illness from ingesting your hair.  Perhaps only then will you surrender to the idea that you can’t stop on your own. 

Step 3: Accept the help

Once you complete step 1 (ask for help) and step 2 (stop the excuses), it is time for step 3 (accept the help). Asking for help and accepting the help are two very different processes.  You may call for help out of desperation but you may not be ready to actually accept any assistance. If you have been telling yourself for years that you should be able to stop on your own, or you have heard comments from others that it shouldn’t be so hard to just stop pulling, you may be resistant to interventions.  

Self-acceptance is a critical aspect of successful treatment.  You may have so much shame and embarrassment about your habit, that you resist help because you do not feel you deserve to be helped.  You may feel that you should be the only one responsible for stopping a behavior that you are physically imposing on yourself.  You may believe that there is something fundamentally wrong with you and that you cannot be “fixed”.  

The idea that you are even acknowledging this problem to a therapist may be so overwhelming that you can’t even begin to conceptualize fixing it.  You may be carefully guarding your pulling as a well-kept secret from family and friends because you do not expect them to understand why you would pick at yourself.   In addition, you do not expect sympathy for a problem that you seemingly create. To add to the shame and embarrassment you already feel, family and friends may reprimand or criticize you.  You may even have loved ones that take it personally and say things like “If you really loved me, you’d stop since you know how much it bothers me”.  

It is much easier to accept professional help when you have a positive support system. You may decide to invite your family or significant others into therapy to help them gain awareness about this stubborn behavior.  Trichotillomania can be explained to them in a way they can comprehend and perhaps even relate to on a personal level.  You can ask them if they have ever had a behavior that they were not proud of and if they had a difficult time breaking it.  Perhaps mention how smoking, drinking, overeating, overspending, and anger outbursts are largely dictated by impulse.  Although you have a certain amount of control over your behaviors, it is sometimes necessary to reach out for extra assistance to control what feels like uncontrollable urges.  Offering explanations that people can relate to helps to gain cooperation and support from those who may otherwise be overly critical of or baffled by the hair pulling behavior.

It is important that loved ones not get involved in “policing” the “trichster” through the therapy process.  It is often best that they remain quietly supportive and patient with the process. When family and friends become overly involved in interventions, it can place undue pressure on an already vulnerable participant.  

Understandably, you would like to believe that you could or should be able to control the habit all on your own. But clearly, as of now, your way does not work.  If it did, you probably would not be reading this article and contemplating treatment right now.  Once this concept is absorbed, you are ready to begin Habit Reversal Training.

Dr. Suzanne Feinstein at Advanced Behavioral Health, LLP is a licensed clinical psychologist who specializes in the treatment of Trichotillomania and other body focused repetitive behaviors. Call 646-345-3010 or email drfeinstein@behaviortherapynyc.com to learn more about Habit Reversal Treatment or to set up an appointment.  

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