All You Need To Know About Trichotillomania Treatment
You've read that trichotillomania is treatable. Then you look into it and find a pile of options: CBT, pills, hypnosis, apps, supplements. This page sorts out which trichotillomania treatment has the most support, what it looks like week to week, and how to start.
By Nathan Peterson, LCSW, OCD and BFRB therapistTreatments for trichotillomania
The main treatment for trichotillomania is a behavioral therapy called habit reversal training, or HRT. It's a type of CBT made for body-focused repetitive behaviors (BFRBs), so it's also the main BFRB treatment for skin picking and nail biting.
Older articles describe CBT for trich as replacing negative thoughts with positive ones. That's not what helps most with hair pulling. HRT is about your hands and your setup, not arguing with your thoughts. Some therapists also add acceptance-based skills, so you can let the urge be there without acting on it.
If you're new to trich, start with what trichotillomania is.
Habit reversal training, step by step
1. Awareness training
You learn when, where, and how you pull. That includes the warning signs, like your hand drifting up, touching your hair, or feeling for a certain texture. Tracking for a week or two usually shows a clear pattern.
2. Competing response
When the urge shows up, you do something with your hands that makes pulling hard, like making a fist, clasping your hands, or holding an object. You keep it up for about a minute, or until the urge drops. The urge is allowed to stay. Your hands go somewhere else while it does.
3. Social support
Someone you trust, like a partner or a parent, can point out when they see you pulling and notice when you use your competing response. This part is optional, and it only works if you both agree on how they'll do it.
I know, "make a fist" sounds too simple for something you've been fighting for years. The simple part is the point. The work is doing it every time, especially the times you don't want to.
For ideas you can try today, see how to stop pulling your hair.
The ComB model
The ComB (comprehensive behavioral) model builds on HRT. It looks at everything that feeds your pulling and gives you a tool for each piece:
- Sensory: the feel of a coarse hair, the sight of a gray one, the texture between your fingers
- Cognitive: thoughts like "one more" or "it has to be even"
- Affective: feelings like stress, boredom, or restlessness
- Motor: hand positions and habits, like leaning your head on your hand
- Place: the spots where pulling happens most, like bed, the car, or the bathroom
That's why two people with trich can end up with different plans. Your plan fits your pattern.
Medication
No medication is approved specifically for trichotillomania. Some doctors prescribe medication to help, and researchers are still studying which ones help and for whom. That's a conversation to have with your doctor or psychiatrist, and it usually works best alongside behavioral treatment, not instead of it.
Resources for those affected by trichotillomania
- A BFRB therapist. Look for someone who uses HRT or the ComB model. The TLC Foundation for BFRBs has a provider directory at bfrb.org.
- A self-guided BFRB program. A structured course walks you through HRT at your own pace, which helps if therapy is hard to find or afford. See BFRB programs.
- Support groups and communities. Talking with other people who pull takes some of the shame out of it, and you pick up ideas that worked for them.
- Your doctor or dermatologist. For medication questions, or for your scalp, brows, and lashes.
Start with awareness. For the next week, write down every time you pull: where, when, which hand, and what you felt right before. (Yes, you'll forget some. Write down that you forgot.)
That list is step one of HRT. If you want the rest of the steps laid out for you, that's what the course below is for.
Common questions about trichotillomania treatment
Is there a cure for trichotillomania?
There's no cure in the sense of a pill that makes it disappear. With treatment, pulling can drop a lot, and the urges get easier to ride out. Some people stop pulling altogether. Others still get the urge sometimes and know what to do with it.
Can I do trichotillomania treatment at home or online?
Yes. Habit reversal training is skills you practice in your own life, so it works well online or self-guided. You can start with a structured course and add a therapist if you want more support.
How do I find a therapist for trichotillomania?
Look for someone who specifically treats BFRBs and uses habit reversal training or the ComB model. The TLC Foundation for Body-Focused Repetitive Behaviors keeps a directory of providers at bfrb.org. It's fine to ask a therapist how they treat hair pulling before you book.
Does hypnosis or acupuncture work for trichotillomania?
There's much less research behind those than behind habit reversal training. If you want to try something, start with the treatment that has the most support, and talk to your provider about anything you want to add.
