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Trichotillomania and Dermatillomania

Trichotillomania and Dermatillomania

Trichotillomania and Dermatillomania are two types of body-focused repetitive behavior (BFRB) disorders. Trichotillomania is a condition in which an individual repeatedly pulls out their own hair, body hair, eyelashes or eyebrows for non-cosmetic reasons (e.g., not as part of grooming practices). Dermatillomania, also known as Excoriation Disorder, is a condition in which an individual repeatedly picks at their own skin for non-cosmetic reasons.

Individuals with body-focused repetitive behaviors (BFRBs) such as Trichotillomania and Dermatillomania may engage in pulling and picking consciously (“focused”), or they may be unaware of pulling and picking as it occurs, only later noticing the effects (“automatic”). Most individuals with BFRBs experience a mix of focused and automatic pulling or picking. Many individuals with BFRBs experience shame or distress in response to their pulling and picking, and experience strong urges to pull and pick despite desire or attempts to stop.

For individuals with untreated Trichotillomania and Dermatillomania, the consequences of pulling and picking can be stressful or even harmful. They may attempt to hide evidence of picking and pulling behaviors. Individuals with Trichotillomania can experience hair loss, thinning or bald spots, or complete lack of eyebrows or eyelashes. This can cause them significant discomfort in social settings. Individuals with Dermatillomania can develop bleeding, bruising, or even infections at as a result of their skin picking. There are many factors which affect where, when, and how much an affected person engages in pulling or picking behaviors.

These factors vary from person to person, but may include:

  • The environment (e.g., only picking in certain rooms, or only when no one else is present)
  • Their mood (e.g., pulling to relieve boredom, anxiety, or frustration)
  • Sensory cues (e.g., feeling as though their scalp is itchy, or their skin is tight, and attempting to relieve the sensation through pulling or picking)
  • Thoughts about the behavior (e.g., “I’ll only pull a few hairs” or “I’ll only pick for a few minutes”)
  • Their posture (e.g., automatically pulling anytime the hands are near the hair)

At The OCD & Anxiety Center we specialize in the treatment of anxiety and related disorders including Trichotillomania and Dermatillomania. We have the necessary training and resources to deliver evidence-based treatment to BFRB sufferers of all ages, as well as those with co-occurring OCD and anxiety disorders. We use a combination of Cognitive Behavioral Therapy (CBT) and Habit Reversal Training (HRT) in the treatment of Trichotillomania and Dermatillomania, as this is the therapy treatment which has proven most effective for the range of BFRBs.

Through CBT, individuals with BFRBs learn to change the way that they think about their behavior to discourage future episodes of pulling or picking (e.g., “Every hair is important” or “I won’t even start”). Through HRT, individuals with BFRBs practice waiting out urges or replacing body-focused behaviors with other, nonharmful behaviors, such as through use of manipulatives.

Clients are also taught to change the environment to decrease the frequency of pulling and picking behaviors. This combined approach helps individuals to gradually gain their lives back from picking and pulling. If you or someone you know would benefit from our specialized Trichotillomania and Dermatillomania treatment services, please reach out to us at (630) 522-3124 today!