Trichotillomania - Treating trichotillomania

Therapy to change your hair-pulling behaviour is the most effective method of treating trichotillomania.

This should be combined with a network of emotional support.

Medications used to treat other psychological health conditions, such as depression and obsessive compulsive disorder (OCD), are sometimes also used in cases of trichotillomaina.

However, there's no evidence to suggest that any type of medication is effective in treating trichotillomania.

Psychotherapy

Psychotherapy is a talking therapy often used to treat emotional problems and mental health conditions. You or your child can discuss emotional issues with a specially trained therapist.

Cognitive behavioural therapy (CBT) is a type of psychotherapy that may be recommended. It can help you address your thoughts about yourself, your relationships with others, and how you relate to the world around you. 

CBT may also involve behavioural therapy, which aims to help you change the way you behave – for example, reducing your hair-pulling behaviour. It's also known as habit-reversal therapy, and could include:

• educating you about your condition and how it's treated 
• making you more aware of when and why you pull your hair out – for example, you may pull your hair out when you're stressed 
• learning a new response to carry out when you feel the urge to pull your hair out – for example, clenching your hand into a fist
• creating barriers that prevent you from pulling your hair out – for example, wearing a hat if you usually pull hair from your scalp   
• involving your parents or partner in your treatment – for example, they could praise and encourage you when you don't pull your hair out

Emotional support

If you have trichotillomania, it's likely you're experiencing emotional distress, such as feelings of self-loathing and guilt.

It's important you receive emotional support to help you cope with these feelings. This may be from family, friends or a self-help group.

In the UK, there are a number of regional trichotillomania support groups you can contact.  

Family therapy

Trichotillomania can be particularly distressing for families of children and young adults who pull their hair out.

Pulling your hair out may be a way of communicating distress to your family, but they may feel powerless to help you. In this situation, family therapy may be suggested.

A therapist will meet the whole family to explore their views and relationships, and understand any problems the family may be having. It helps family members communicate better with each other.

Family therapy can be particularly useful when a child or young person has a serious problem, such as trichotillomania, that's affecting the rest of the family.

The family can work together to address the issue that's causing you to pull your hair out, and seek support for any distress caused to other family members.

Medication

Several medications have been used to treat trichotillomania, although there haven't been many large-scale clinical trials on them.

If the healthcare professional treating you recommends a particular medication, they should discuss the possible risks and benefits with you, including any side effects.

Selective serotonin reuptake inhibitors (SSRIs)

In the past, selective serotonin reuptake inhibitors (SSRIs) have been used to treat trichotillomania, although there's some evidence to suggest they're not effective. SSRIs are often used to treat depression and anxiety disorders.

For children under the age of 18, the recommended SSRIs are sertraline and fluoxetine. These should only be used under the supervision of a mental health specialist, such as a specialist child and adolescent psychiatrist. This is a qualified medical doctor who's been trained in treating childhood mental health conditions.

Clomipramine

Clomipramine is another medicine that may be recommended for trichotillomania. It's often used to treat depression and obsessional states.

A child under 18 years of age being treated with clomipramine should be supervised by a specialist child and adolescent psychiatrist.

Clomipramine has been tested as a treatment for trichotillomania and has been found to be effective at reducing hair-pulling behaviours.

Other medicines

Small trials have been carried out for other medicines, but not enough is known about their effectiveness. In particular, there's a lack of research into medicines used to treat children with trichotillomania.

Wigs and appearance tips

If you're concerned about the bald patches on your head, you can buy wigs made from real hair or man-made fibres. Wigs made from real hair look more natural, but are more expensive and harder to look after.

Wigs are available from the NHS, but you'll usually have to pay for them unless you qualify for help with charges.

If you've pulled out your eyebrow hair, it may be possible to use an eyebrow pencil or have tattoos. You can use false eyelashes if you've pulled out your eyelashes, or you can use make-up to add more definition to your eyes.

Alopecia UK has some useful information about wigs, plus a section about appearance tips that you may also find helpful.