Anecdotal evidence suggests that trich follows a fairly predictable course over one’s lifetime. Most symptoms start around middle to late childhood with the onset of puberty and increases in severity during adolescence and twenties. However, most people experience lower symptom severity in their 30s and 40s. The changes later in life may result from a variety of factors including changing hormones, improved sense of self or learning to manage pulling behaviors through therapy. However, neurology points to something else.

Good old-fashioned psychotherapy remains the most effective treatment for trichotillomania. A recently published evaluation of the research suggests that pharmacological treatments lag behind behavioral and cognitive-behavioral therapies.  

The Research Says

A meta-analysis looks at all the available research conducted within a subject area to determine if broader conclusions can be made. In the case of this meta-analysis, the researchers looked for psychological and pharmacological interventions for trichotillomania used with children under age 18. Although they found 129 studies conducted, only 6 met the criteria of being a well-designed study.

What other conditions are most closely related?

In an effort to understand the risk factors for trichotillomania, researchers continue to look for genetic links between trich and other disorders. As a member of the obsessive-compulsive disorder (OCD) diagnostic family, there are many similarities between the disorders. One of the most common reasons for misdiagnosis is that trich looks very much like OCD. This blog article from the archives offers a refresher on the differences.

Treatments for trichotillomania run the gamut with cognitive-behavioral therapies such as habit reversal training and acceptance and commitment therapy ranking high for level of effectiveness. However, a study conducted in Australia presents another form of treatment modality using peer support that shows promise.

Holistic Recovery

During treatment, people with trich learn to manage behaviors, but they also work through the emotional toll of pulling. Many people with trich feel embarrassment, shame, and guilt because the disorder affects appearance, which increases social judgment. Therefore, addressing those feelings as well as anxiety, stress, depression, trauma or other mental health issues that accompany trich is an essential part of therapy. Often, social support in the form of groups or connecting with others further along in recovery gives people a boost. However, one challenge with compulsive hair pulling is its chronic, episodic nature which means a person can feel like recovery is a success and then experience a lapse.

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