Trichotillomania/TTM (compulsive hair pulling)

Excoriation Disorder (dermatillomania, compulsive skin picking)

Trichotillomania and Excoriation Disorder are disorders characterized by chronic and compulsive hair pulling or skin picking.  TTM includes pulling out hair from any part of the body.  Individuals with TTM or Excoriation Disorder experience worry, distress, frustration, and embarrassment.  Episodes of hair pulling or skin picking are preceded by high tension levels and urges to pull.  Often, hair pulling results in relief or pleasure.  Hair pulling and skin picking are sometimes triggered by stressful events or negative mood states.  Individuals may avoid situations to hide hair loss from others.

Treatment of Trichotillomania/Excoriation Disorder:

Developed by Dr. Charles Mansueto, the most effective treatment employs cognitive-behavioral therapy (CBT) techniques. These include the ComB (comprehensive behavioral treatment) and SCAMP (sensory, cognitive, affective, motoric and place modalities) models.  The models utilize CBT techniques such as habit reversal training (HRT), stimulus control techniques, and cognitive restructuring.  

Examples of therapy goals to decrease hair pulling and skin picking:

• Design a treatment plan to address your individual needs and concerns.
• Identify trigger situations for pulling or picking.
• Develop a variety of strategies and coping tools to manage hair pulling and skin picking and resist the urges. 
• Develop habit replacement behaviors and stimulus control strategies.
• Learn to respond differently to thoughts about your hair or skin.
• Develop coping tools to manage stressful situations. 
• Help loved ones understand and develop ways to respond to pulling/picking behaviors.
• Family education.
• Relapse prevention strategies.