Trichotillomania and Skin-picking Therapists

What are Trichotillomania (Hair-Pulling) Disorder and Excoriation (Skin-Picking) Disorder?

Trichotillomania and Excoriation Disorder fall under a category of behaviors called Body-Focused Repetitive Behaviors. They are characterized by repetitive, impulsive behaviors that are hard to resist in which pulling, picking, scratching, or scraping of the skin, nails, or hair result in damage to the body or noticeable hair loss.

Common Symptoms

• Recurrent pulling of one’s hair, sometimes leading to hair loss
• Recurrent skin picking, sometimes resulting in skin lesions
• Repeated attempts to decrease or stop hair pulling or skin picking
• Skin picking or hair pulling causes significant distress or impairment in social, occupational, or other important areas of one’s life

Trichotillomania and Excoriation Disorder Treatment

Both of these disorders are best treated by unique forms of Coginitive-Behavioral Therapy (CBT), which help reduce the behavior itself as well as its social and emotional impact. The two forms of CBT recommended to treat these disorders are called Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB). These forms of therapy aim to eliminate hair pulling and skin picking by first increasing awareness of triggers to these behaviors. Next, skin picking and hair pulling are replaced with more effective means of managing stress and other difficult emotions. Sometimes, barriers to engaging in the behavior (e.g. Band-aids or tape on the fingers) are used as well. Practice of these new skills is completed in therapy through exposure to triggers.