NHS Choices – Aug 2012
Therapy to change your hair-pulling behaviour is the most effective method of treating trichotillomania.
This should be combined with a network of emotional support (see below).
There are also a number of other possible treatments for trichotillomania, although little in the way of medical research has been conducted to determine how effective they are.
Psychotherapy is a talking therapy often used to treat emotional problems and mental health conditions. You or your child can discuss emotional issues with a specially trained therapist.
Cognitive behavioural therapy (CBT) is a type of psychotherapy that may be recommended. It can help you address your thoughts about yourself, your relationships with others and how you relate to the world around you.
CBT may also involve behavioural therapy. This aims to help you change the way you behave – for example, reducing your hair-pulling behaviour. It is also known as habit-reversal therapy and could include:
- educating you about your condition and how it is treated
- making you more aware of when and why you pull your hair out – for example, you may tend to pull your hair out when stressed
- learning a new response to carry out when you feel the urge to pull your hair out – for example, clenching your hand into a fist
- creating barriers that prevent you from pulling your hair out – for example, wearing a hat if you usually pull hair from your scalp
- getting your parents or partner involved in your treatment – for example, they could praise and encourage you when you do not pull your hair out
Other possible psychological approaches are discussed below. These have not been studied closely, so their effectiveness in treating trichotillomania is unknown.
Hypnosis can be used to alter your state of consciousness. While you are hypnotised, the hypnotist can suggest you change your behaviour.
In this altered state, you may be more likely to accept suggested changes and stop pulling your hair out.
Strategies that help you relax may be useful for controlling trichotillomania. This may include deep breathing exercises or tensing and then relaxing different muscles.
Read more about relaxation strategies.
If you have trichotillomania, it is likely you are experiencing emotional distress, such as feelings of self-loathing and guilt.
It is important you receive emotional support to help you cope with these feelings. This may be from family, friends, or a self-help group.
In the UK, there are a number of regional trichotillomania support groups you can contact.
Trichotillomania can be particularly distressing for families of children and young adults who pull their hair out.
Pulling your hair out may be a way of communicating distress to your family, but they may feel powerless to help you. In this situation, family therapy may be suggested.
A therapist will meet the whole family to explore their views and relationships and understand any problems the family may be having. It helps family members to communicate better with each other.
Family therapy can be particularly useful when a child or young person has a serious problem, such as trichotillomania, that is affecting the rest of the family. The family can work together to address the issue that is causing you to pull your hair out, and seek support for any distress caused to other family members.
Several medications have been used to treat trichotillomania, although there have not been many large-scale clinical trials on them.
If the healthcare professional treating you recommends a particular medication, they should discuss possible risks and benefits with you, including any side effects.
Selective serotonin reuptake inhibitors (SSRIs)
In the past, selective serotonin reuptake inhibitors (SSRIs) have been used to treat trichotillomania, although there is some evidence to suggest they are not effective. SSRIs are often used to treat depression and anxiety disorders.
For children under 18 years of age, the recommended SSRIs are sertraline and fluoxetine. These should only be used under the supervision of a mental health specialist, such as a specialist Child and Adolescent Psychiatrist. This is a qualified medical doctor who has received further training in treating childhood mental health conditions.
Clomipramine is another medicine that may be recommended for trichotillomania. It is often used to treat depression and obsessional states. A child under 18 years of age being treated with clomipramine should be supervised by a specialist child and adolescent psychiatrist.
Clomipramine has been tested as a treatment for trichotillomania and has been found to be effective at reducing hair-pulling behaviours.
Small trials have been carried out for other medicines, but not enough is known about their effectiveness. In particular, there is a lack of research into medicines used to treat children with trichotillomania.
Contact: Linda Alexander on 0141 632 1440 and 07875 493 358, also email@example.com
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