Trichotillomania, What is it and How to get Help in San Diego?
by Katherine Pica LCSW
Trichotillomania is characterized by the habitual and overwhelming urge to pull hair from one’s own scalp, eyebrows, or other parts of the body. Individuals with trichotillomania experience varying degrees of severity—for some, symptoms can persist chronically or may only be temporary.
Trichotillomania is a type of Body Focused Repetitive Behavior or BFRB. There are many different types of BFRBs including skin picking, nail biting or picking and cheek biting etc.
People with trichotillomania or BFRBs often do not feel in control of their actions or impulses even when the consequences are negative. Trichotillomania can result in significant hair loss and resulting distress or discomfort. Still, individuals suffering will find it difficult or impossible to fight the urge to pull and pluck at their hair.
Symptoms of a BFRB
The most commonly affected area in trichotillomania is the scalp. Affected areas can also extend to other parts of the body, such as the eyebrows, eyelashes, pubic areas, or underarms. Someone with trichotillomania might pull out individual strands of hair for extended hours at a time.
Hair-pulling can be intentional or automatic. Intentional hair-pulling can occur because of an uncontrollable desire to relieve stress, whereas automatic hair-pulling occurs during periods of distraction or boredom.
Other signs and symptoms may include:
Overwhelming anxiety to hair pull
A feeling of relief from hair-pulling
Chewing or biting pulled-out hair
Playing with pulled-out strands of hair
The urge to pick at one’s skin and nails
Increased hair loss and skin irritation from hair-pulling
Symptoms commonly first occur in individuals between the ages of 10 and 13. Left untreated, these symptoms can increase in severity over time.
Causes of BFRBs
There is not a single, identifiable cause of trichotillomania. A combination of biological and environmental factors can contribute to a person’s trichotillomania, including:
Genetic factors: Someone with a family history of trichotillomania may be more predisposed to the disorder.
Stress: High levels of stress in one’s daily life can intensify someone’s urge to hair-pull.
Levels of anxiety: Some people might hair-pull when they feel a high level of anxiety, while others might hair-pull when they feel relaxed.
Age: Trichotillomania typically first develops in children during the onset of puberty.
We can find other mental health conditions like OCD that are commonly found with trichotillomania, including anxiety, depression, and post-traumatic stress disorder. Any of these disorders can increase a person’s risk of developing trichotillomania or exacerbate existing symptoms. Trichotillomania is also commonly associated with obsessive-compulsive disorder (OCD).
Complications of BFRBs
Individuals with trichotillomania might also experience significant emotional distress because of self-esteem issues related to their hair-pulling. This can include social anxiety in professional and intimate situations because of shame or embarrassment associated with one’s hair loss.
People with trichotillomania might also bite or chew their hair, resulting in gastrointestinal issues due to hairballs. This is a serious concern and should be followed by a medical professional. The results of hair-picking and pulling can also cause pain and skin irritation at the affected areas.
Treatment of Trichotillomania and/or a BFRB
How to treat Trichotillomania and BFRBs
Habit reversal training. This is a behavior therapy for trichotillomania. It includes awareness training so you learn to recognize situations where you're likely to pull, and then you are taught substitution behaviors instead. For example, you might clench your fist when you notice the urge to pull.
ComB Treatment - Comprehensive Behavioral Treatment - This model uses elements of habit reversal therapy but it adds so much more depth to the treatment. This model looks at the whole picture. The treatment model believes that people pull because it meets a need. It may soothe you or maybe it helps stimulate you when you are bored.
It provides individualized treatment for each client. Rather than using a cookie-cutter approach, it really first takes into account the factors that go into the individuals' pulling.
What would therapy look like in BFRB ComB treatment?
We survey and treat these 5 areas:
Sensory or sensations - Often looking for a trigger or some type of pull towards the hair or skin. Some people will describe and itch or tingling sensation or a pull. Sometimes that hair does not fit or feel right. For some, there is pleasure experienced when they pull, or they enjoy the sound of pulling. Some look and touch the hair or skin after it's pulled. Some put it up it near their mouth or in their mouth
Cognitive - We take a look at how our thoughts are affecting the pulling. Sometimes thoughts could be “I have had a rough day so I need to pull to feel better.” Or maybe the thought is “I am really stressed for time and I need to get this project done so If I just pull now I can get through this project and deal with this later. It's too hard to stop. I have too much to do. Or “This nail doesn't feel right. It needs to go so I can think about other things.”
Affective- How our mood affects pulling or picking. Sometimes being bored will spark a pulling episode. For others, feeling worried or anxious will start the trigger to pulling. For others, feeling sad or mad can affect the pulling.
Motoric - this refers to physical movement when you pick, and we pay attention to how aware you are when you pull or pick. We look at the habits and patterns of behavior and the consequences of those
Place- or environment- We take a look at where you are when the picking and pulling often happens. Are you watching TV at night in the living room. Who is in the room with you who can see you picking or pulling?
How to find a BFRB therapist in San Diego
Here at Resilience Counseling, we are trained in the COMB and HRT model and use it for the treatment of BFRBs and Trichotillomania. We are a group of trained BFRB therapists. All team members have been trained by Katherine Pica, LCSW, founder and clinical director of Resilience Counseling. We have helped many clients overcome the struggles from Trichotillomania and BRFBs, and we are confident that we have the skills and tools to work together. Local to San Diego , CA, and able to see clients virtually all over California. Contact us to set up a free 15 minute phone consultation today.
Author Bio: Katherine Pica OCD Treatment - San Diego, CA
Katherine Pica, LCSW, is the Clinical Director and Practice Owner of Resilience Counseling. With 19 years of clinical experience, Katherine provides leadership and supervision to the therapy team, supporting high quality, evidence based care. Resilience Counseling specializes in the treatment of OCD, trichotillomania, trauma, anxiety, and related concerns, using evidence based approaches including ERP, HRT, the ComB model, and EMDR when appropriate. In person sessions are available in San Diego, CA, with virtual therapy offered throughout California. Contact us today to take the first step toward healing and meaningful change.
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