Trichotillomania (TTM) is categorized as an Impulse Control Disorder. TTM is the recurrent pulling out of one’s own hair, often resulting in noticeable hair loss. Individuals with TTM typically pull from their scalp, eyebrows, or eyelashes; less common areas for pulling include the pubic area, arms, legs, and chest. TTM is characterized by a feeling of tension prior to the hair pulling and sustained tension if the urge to pull is resisted. Some individuals also experience an itch-like sensation prior to the hair pulling. After the hair is pulled, the individual experiences a feeling of relief, gratification, or pleasure. Hair pulling may occur both during times of stress or when the individual is relaxed. Likewise, the behavior may occur continuously throughout the day or during specified times. Hair pulling may be accompanied by chewing the hair roots, running the hair through the teeth, or eating the hairs. TTM occurs in approximately 0.6% of the population (about 1 in 200 people) and is experienced more often by females than males in adulthood.
Habit reversal is the specific CBT technique used to treat TTM. Habit reversal involves three steps: awareness training, competing response, and social support. Because the behavior may occur during times of relaxation such as when watching television or talking on the phone, it is crucial for the individual to notice when they are pulling. Additionally, awareness training allows the individual to recognize the thoughts that precede the urge, if the pulling occurs as a result of stress. The competing response gives the person an alternative to pulling when the urge arises. A common competing response is clenching the fists and releasing. Finally, social support is a crucial aspect of treatment, as others assist in awareness, recognize improvements, and provide encouragement.