The best treatment for trichotillomania depends on the individual needs of the person suffering from this compulsive hair-pulling disorder. The goal of treatment is to reduce the urge to pull repeatedly on the hair, or if the person is unable to lose the desire to pull his hair, the goal becomes to resist the physical action of hair pulling. The best trichotillomania therapy is often a combination of medication and behavioral modification therapy.
Most medications prescribed for trichotillomania are tricyclic antidepressants or selective serotonin reuptake inhibitor (SSRI) antidepressants. It is believed that there is a chemical imbalance that predisposes certain people toward obsessive-compulsive behavior such as hair pulling. The medications may not be suitable for everyone seeking treatment for trichotillomania, as the side effects may outweigh the benefits of the antidepressant. The side effects of antidepressants may include nausea, dry mouth, dizziness, and weight gain.
Behavioral therapy for trichotillomania often begins with an assessment of the triggers for the hair pulling. Once these triggers are identified, the therapist will be able to develop a plan for coping with these stressors. The therapist may recommend breathing exercises and meditation to reduce the urge to pull hair. Hypnotherapy also has been an effective tool for a select few suffering from trichotillomania.
Some believe that biofeedback therapy is a beneficial treatment for trichotillomania. The therapy sessions can include identifying the sensations that accompany the urge to pull hair, including tension in the facial muscles and a restless feeling in the hands. The therapist then would help the person discover alternative actions or breathing techniques that may quiet the compulsion to pull hair. Daily sessions listening to peaceful, relaxing music also may decrease the need to self-soothe with hair pulling.
Many therapists will ask the person looking for trichotillomania treatment to keep a record of when he has the urge to pull his hair. The logbook should include the time of day and all other details of the hours prior to a trichotillomania attack. It may be that avoiding certain activities or people may help avoid further episodes of hair pulling.
Most people needing treatment for trichotillomania will respond best to a combination of behavioral therapy and medications. A relapse into hair pulling is not unusual, even after therapy. A behavioral modification technique called Habit Reversal Training (HRT) has been found to be successful in helping people who are unable to quit pulling their hair. HRT teaches the patient how to change the thinking patterns that accompany the physical action of pulling hair. It helps the person focus on a different way to relieve stress that does not have the adverse effects of hair loss.