Home » Blogs » Therapy Soup » Cause And Treatment Of Trichotillomania

Cause And Treatment Of Trichotillomania

Dr. Marla Deibler

More with Marla Deibler, PsyD, on trichotillomania, a hair pulling disorder. For our first post on this topic, see When Hair Pulling Is A Problem.

Welcome back, Dr. Deibler. At what age does trich (trichotillomania), generally begin?

The average age onset is between 11 and 13 years of age, although hair pulling behavior may begin as early as the first year of life.

It is believed that hair pulling prior to age 5, known as “baby trich,” may be a distinct phenomenon and is often transient, while the typical pattern of symptoms in children and adults is chronic with a course that waxes and wanes over time.

What causes trich?

Research suggests that trichotillomania is associated with genetic vulnerability; that is, the disorder occurs more frequently in the first degree relatives of individuals with trichotillomania, than it occurs in the general population. Other factors that may contribute to the onset include personality/temperament, life stressors, environmental factors, gender, and age.

Hair pulling and other excessive grooming behaviors have not only been observed in humans.  Over-grooming behavior has been observed in a wide range of species; animal models as well as human behaviors are being studied to further the understanding of trichotillomania and related behaviors.

Are there co-occurring disorders? Do family-of-origin problems play a role in causing this disorder?

Trichotillomania may occur in the absence of additional psychopathology or may coexist with a wide range of psychiatric disorders.  It may be comorbid (exist along with) with other body-focused repetitive behaviors, mood disorder, or anxiety disorder, among others.

Also, it is not considered to be related to self-mutilating behaviors, such as cutting. Research doesn’t suggest any relationship between trichotillomania and unresolved trauma or deep-seated emotional issues.  With the exception of genetics, there is no evidence that family of origin plays a role in the development of the disorder.

Is there a lot of research being done on this disorder? 

Trichotillomania research remains young in its development. Much of the literature on this disorder and related disorders is less than 20 years old, with the majority of literature published in more recent years.

What treatments are available?

First and foremost, education and family/social support are essential to the successful treatment of trichotillomania. The evidence-based “treatment of choice” for trichotillomania is specific cognitive-behavioral therapy (CBT), ComB (Comprehensive Behavioral Model; Mansueto, et al., 1999).

ComB primarily involves increasing awareness of the behavior and clarifying the pattern of the behavior so that “triggers” to pulling may be identified as well as ways in which to prevent and/or interrupt the behavior pattern and redirect the response to pulling “triggers” in order to create new behavior patterns and reduce or eliminate urges to pull.

Other evidence-based therapies include habit reversal training, and, more recently, adjunctive Acceptance and Commitment Therapy (ACT), and Dialectical Behavior Therapy (DBT).

No medication is currently indicated for the treatment of trichotillomania.  Some individuals report benefit from medication in terms of improving mood or reducing anxiety, although no medication has been clearly demonstrated to be effective for reducing hair pulling. N-acetylcysteine (NAC) is an amino acid that has shown promise in the treatment of the disorder and is currently being investigated further.

Many individuals find participating in a support group and having contact with others who have Trichotillomania and others with body focused repetitive behaviors to be very helpful in achieving acceptance, treatment, and recovery.

One more post on trichotillomania with Dr. Marla Deibler coming soon.

You can learn more about trichotillomania from the Center for Emotional Health’s information booklet (PDF) and from the Trichotillomania Learning CenterDr. Deibler’s web site, her Facebook page, and her YouTube channel, and you can follow her at Twitter.

Cause And Treatment Of Trichotillomania

Richard Zwolinski, LMHC, CASAC & C.R. Zwolinski

Richard Zwolinski, LMHC, CASAC is the author of Therapy Revolution: Find Help, Get Better, and Move On Without Wasting Time or Money and is licensed in addiction and psychotherapy with over 25 years experience as well as a consultant to organizations and companies in the fields of mental health and addiction. He is the executive director of an outpatient behavioral health program. Learn more about Richard here.

3 comments: View Comments / Leave a Comment



APA Reference
& C.R. Zwolinski, R. (2013). Cause And Treatment Of Trichotillomania. Psych Central. Retrieved on September 21, 2020, from


Last updated: 3 Oct 2013
Statement of review: Psych Central does not review the content that appears in our blog network ( prior to publication. All opinions expressed herein are exclusively those of the author alone, and do not reflect the views of the editorial staff or management of Psych Central. Published on All rights reserved.