Trichotillomania (hair pulling)

Trichotillomania (TTM), or compulsive hair pulling, is a habit that can cause significant distress and impairment.  While not always the case, individuals with TTM often present to treatment with noticeable hair loss (e.g., bald patches) as a result of pulling, twirling, or playing. While the specific site of hair pulling varies from person to person, it can include the scalp, eyebrows, sideburns, facial hair, pubic region, extremities (e.g., arms and legs), and others.  In some cases, individuals may save or eat the removed hair.

Many individuals report a need to complete the pulling because of a sense of tension that builds up beforehand. Similarly, many cite a sense of relief or enjoyment upon performing the behavior. Boredom and stress tend to be common triggers. Also, individuals with TTM report enjoying the texture of hair or the feeling of pulling, which can elicit the behavior.

TTM can be successfully treated using a cognitive-behavioral therapy (CBT) approach called habit reversal training. This involves developing self-awareness of the pulling and its environmental contingencies, as well as devising and practicing alternative behaviors to compete with the pulling behavior. Habit reversal training is supplemented with adjunctive CBT techniques, such as emotion regulation skill development, as necessary.