What Is Trichotillomania? And How Is It Treated?

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


April 30, 2015

In This Article

Causes and Treatment

Medscape: Do we know anything about what causes trichotillomania? Are there associated risk factors?

Ms Muller: The etiology of trichotillomania is still unknown. However, we do know there are various factors to consider. Neurobiological research via brain scans demonstrates the structure and functioning of persons with trichotillomania to differ from that of control participants, persons with attention-deficit/hyperactivity disorder (ADHD), persons with tic disorder, and persons with obsessive-compulsive disorder (OCD). There is a genetic component in some cases; we have identified families in which trichotillomania is diagnosed in parent and child, or siblings.

Personality traits (low tolerance to stress, perfectionism, low tolerance to anxiety) are apparent. Sensory processing, such as overstimulation or understimulation from an environmental or physical standpoint, is also relevant when discussing etiology. As in all other mental health disorders, there are exceptions. Additional areas of further research that have been reported include the relationship between pulling urges and sugar consumption, caffeine consumption, and lack of sleep.

Risk factors include family history; age (peak onset is most often between age 11 and 13 years); poor coping mechanisms for emotional regulation; premorbid mental health diagnoses, such as ADHD, OCD, tic disorder, an eating disorder, an anxiety disorder, or depressive disorder; and the personality traits mentioned above.

Medscape: How is trichotillomania treated and managed?

Ms Muller: Empirically validated treatment for trichotillomania includes cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT), which is the third wave of treatment approaches and a branch of CBT. ACT teaches patients to recognize, accept, and embrace urges without acting on them. Behavioral approaches, such as habit reversal, stimulus control, and awareness training, are also used and are efficacious.

Regarding medication, research is not overwhelmingly positive on prescribing medication for trichotillomania. Some patients benefit from use of a selective serotonin reuptake inhibitor in conjunction with psychotherapy, whereas others do not.

There is no cure for trichotillomania, but freedom from it is possible by recognizing the behavior, increasing awareness of the thoughts and feelings driving the urges, understanding that urges are different from behaviors, breaking the habitual cycle of pulling with behavioral interventions, increasing positive coping skills, and incorporating sensory regulation methods.


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