Treating Trichotillomania

Abstract

Trichotillomania (TTM) involves the compulsive pulling of one’s bodily hair and is often associated with significant distress or impairment. The present case study concerns a college-aged woman, whose history of TTM extended over 5 years and had been unsuccessfully treated by psychotherapy and medication management. Although TTM can be a challenging disorder to treat, the literature indicates that cognitive-behavioral therapy (CBT) has been successful in this regard. Therefore, we implemented CBT based on the manual developed by Keuthen, Stein, and Christenson; specific elements of therapy used included relaxation, self-monitoring, habit reversal training (HRT), reinforcement/punishment contingencies, thought monitoring, and cognitive restructuring. This approach was successful, as the client evidenced a 72% decrease in hair-pulling after using HRT alone, and complete elimination of hair-pulling after introducing the cognitive-restructuring element. Impressively, the gains lasted not only in the short term, but also had been reportedly maintained at a 5-year follow-up.

Comprehensive Behavioral Treatment of an Older Adult Man with Trichotillomania

“…We would not necessarily have advised Walter to cut his own hair, to wear a headband, or to use copious quantities of rash ointment, but these methods appear useful for him and are certainly not contrary to the ComB model. In a related context, Lootens and Nelson-Gray (2016) made a similar point that the patient, the therapist, and standardized treatment manuals can all be valuable and creative sources of ideas for useful interventions to fit the specific circumstances of a patient with TTM.…”