Trichotillomania (TTM) and other Body-Focused Repetitive Behaviors (BFRBs)

TTM- compulsive non-cosmetic hair pulling- occurs in approximately 1.5% of males and 3.5% of females.  Most people who begin hair pulling are in their early teens. Women and girls are the ones most likely to seek treatment for their hair pulling, perhaps because hair loss is viewed as being less cosmetically acceptable in females than in males. Those who suffer from hair pulling experience intense shame and distress. They may avoid activities that they fear will reveal their hair loss such as being outside on windy days, standing near people taller than themselves, dating, exercise classes, swimming, or going to hairdressers. Those who suffer from TTM often incorrectly fear that hair pulling must indicate that they are especially “sick” or “self-injurious” because they are unable to stop. However, researchers and therapists who are familiar with hair-pulling know that this behavior is a "habit" that is probably caused by a genetic predisposition that accidentally becomes self-reinforcing.

Other BFRBs include compulsive skin picking, compulsive nail biting, cheek biting, and nose picking. Their clinical presentation is very similar to TTM, as is their impact on the family and the sufferer’s self-image. BFRBs often co-occur with TTM, and the same treatment approach is used for both. 

Treatment of BFRBs involves detecting and defining the individual's profile for the unwanted behavior. Since no two individuals with these conditions are alike, a customized plan of behavioral and cognitive strategies must be developed for you. These strategies are applied to gradually help you learn to dismantle the automatic chain of events that leads to the unwanted behavior of pulling and to replace it with more adaptive behaviors. Techniques such as awareness training, habit reversal training, stimulus control, exposure therapy, cognitive therapy, and backward chaining may be used. The goal of treatment is to achieve either a substantial decrease or abstinence from the unwanted behavior.  

We have specialized experience in helping individuals learn to overcome body-focused repetitive behaviors one step at a time.