What Is Trichotillomania? And How Is It Treated?

Bret S. Stetka, MD; Lindsey M. Muller, MS

Disclosures

April 30, 2015

In This Article

A Personal Account

Medscape: If you are comfortable doing so, can you tell us a bit about your own struggle with the condition?

Ms Muller: I started with skin-picking and nail-biting from a young age (approximately 4). Over time, these behaviors subsided, and I began pulling my hair in seventh grade until 2008 (when I was 24 years old). It was a daily and constant struggle as I tried to fight the urges day after day. Each time, I would lose the fight. The more I focused on not pulling, the more I pulled.

I tried CBT, many medications, hypnosis, and wearing something on my head at all times. Each tactic seemed to work in the beginning (the placebo effect), but the results never lasted. It was frustrating and disheartening. I felt alone, ashamed, guilty, damaged, and lost.

In 2008, I found freedom from hair-pulling when I came to understand that pulling was a choice. I could not choose whether or not I had an urge, but I could choose what to do with that urge. I waited several years until I felt enough distance and separation from my own struggle before I opened my doors to patients.

Medscape: Do you have any final thoughts for a clinician audience on how to approach this condition and discuss it with their patients?

Ms Muller: For clinicians who may not be familiar with treatment of trichotillomania, it is important to recognize that this disorder is not treated like OCD, but requires specialized understanding and treatment approaches.

And for all clinicians, I would like to share that trichotillomania is almost always a symptom of something else. Treating the behavior as "just a behavior, or just a habit" is not going to address what is underlying the behavior. To really make progress, the following questions should be explored and answered: "What is driving the urges? Where are they coming from?" When treating patients, I tend to view trichotillomania as a messenger or a red flag that something is out of alignment or has gone awry.

Finally, patients may get worse before they get better as personal experiences, deep-rooted emotions, and core beliefs are brought to the surface.

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