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Bill WhiteBill White
A blog about mental and emotional health

Let's Learn: Trichotillomania (Part 2)

Bill White Updated: Dec 1st 2010

As we discussed in Part 1, trichotillomania, what I'll refer to as trich, is a disorder featuring the impulsive pulling of hair. Understandably, its emotional impact can be absolutely devastating. In this final piece of the series, let's take a look at some management strategies and techniques.

girl blowing a dandelionThe psychotherapy of choice for trich is a form of cognitive behavioral therapy known as habit reversal training (HRT). Foundational in HRT is helping the client connect-the-dots in terms of awareness, so he/she will come to understand their hair-pulling is a conditioned response to an event or situation.

This is super important because all too often the client may be in what appears to be a trance in the midst of a hair-pulling episode - totally unaware of what they're doing. So, indeed, the client needs to come to grips with his/her behavior and the present environmental circumstances. Pivotal in this endeavor is a detailed behavior/circumstances journal that can be reviewed by both the client and his/her therapist.

The next order of business is some body work. First up is learning progressive muscle relaxation techniques, which are to be practiced on a daily basis. And then the client learns techniques of diaphragmatic breathing. This is breathing at, or below, the diaphragm instead of up in the chest or collarbones. A muscle tensing activity known as competing response is also introduced. This is a very cool and precise movement protocol that's the reverse of hair-pulling and considered to be physically incompatible with it.

Finally, when the individual is ready, all of the body techniques are pulled together to form what's called a full habit reversal response. And it's all about establishing a life-theme of relaxation to prevent trich behaviors, as well as develop a coping strategy should the urge to pull present.

So much of what we've just discussed is related to the Buddhist phenomenon known as mindfulness - a clear-minded, in-the-present-moment, self-observational technique that emphasizes viewing self without criticism or judgment. Appropriately, Buddhist nun and Tibetan Buddhism teacher and author, Pema Chodron, explains, "The root (of mindfulness practice) is experiencing the itch as well as the urge to scratch, and then not acting it out."

Now, one can incorporate other techniques to supplement HRT, one of these being stimulus control (SC). This is a behavioral technique that helps individuals identify, avoid, or change the activities, environments, routines, and circumstances they've associated with their hair-pulling episodes. It's a matter of awareness and management, deleting old associations and replacing them with freshly learned connections between urges to pull and non-destructive behaviors.

Other valuable techniques in managing trich are positive self-talk, guided imagery, and visualization. And there's the medication angle, as well. The selective serotonin reuptake inhibitor (SSRI) antidepressants, paroxetine (Paxil), sertraline (Zoloft), fluvoxemine (Luvox), citalopram (Celexa), and fluoxetine (Prozac) have provided relief for those enduring trich. As with any emotional or mental health disorder, the combination of psychotherapy and meds is often a powerful one-two knockout punch.

So there you have it, between Parts 1 and 2, the scoop on trichotillomania - what it is and how best to manage it. As you leave the series, please engrain in your mind the importance of awareness, daily practice of management techniques, and coming to the understanding that the reality of life suggests the occasional pulling "oops" will occur.

All is not lost!


Bill White

After enduring decades of anxiety, depression, and alcoholism; Bill made it out of the woods. He found his life’s passion along the way, earned his counseling credentials, and is ready to lend a hand. Visit his blog at, and you can contact Bill at

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