Dialectical Behaviour Therapy Enhanced Habit Reversal Training: A Clinical Case of Childhood-Onset Trichotillomania in an Adult With Impulsive Personality Features

Abstract

Research has recognised the psychosocial impairments linked to Trichotillomania (TTM) and established a relationship between problematic hair-pulling and affective regulation. Significant relationships between pulling triggers, their severity, and emotional dysregulation have also been predicted. The current case focused on the efficacy of combined DBT (Dialectical Behaviour Therapy) and HRT (Habit Reversal Training) in a client with TTM and Impulsive Personality features. The client received 11 weekly sessions of DBT-enhanced HRT, which took 3 months to complete. Following the end of this acute treatment phase, four maintenance sessions (two sessions per month) were delivered. The maintenance of treatment benefits was assessed using self-report measures and therapist observations at four time points: at pre-treatment, after the acute treatment phase (at the end of 3 months), and then at a 3-month and a 6-month follow-up. The intervention results suggested a substantial reduction in hair-pulling, hair regrowth in affected parts of the scalp, and self-reported improvements in mood. The study also shows preliminary evidence of DBT-enhanced HRT’s efficacy in a client with TTM and Impulsive Personality features, suggesting the importance of addressing personality structures and distressing emotional regulation that cause functional impairment during TTM treatment.

Examining the Effectiveness of Dialectical Behavior Therapy on Impulsivity, Emotion Regulation, Rumination, and Self-Criticism in Individuals with Trichotillomania

“…DBT emphasizes acceptance and change, where therapists validate patients' experiences while also encouraging personal growth and skill development (25). Research shows that DBT has proven effective in reducing symptoms of eating disorders, mood disorders, emotional disorders, and anxiety disorders (26,27). Due to the importance of treating trichotillomania and its increasing prevalence in recent years, as well as the research gap regarding the investigation of the effectiveness of DBT on impulsivity, emotion regulation, and rumination in patients with trichotillomania, this study was conducted.…”