Behavioral Treatment of Trichotillomania in a College Woman: A Case Study

Trichotillomania (TTM) is a disorder that involves repetitive pulling of one’s hair to the point of hair loss and clinically significant distress or functional impairment. Using Diagnostic and Statistical Manual of Mental Disorders-5 ( DSM-5) criteria, which include repeated attempts to decrease or stop pulling, the 12-month prevalence of TTM is 1% to 2%. Treatment commonly involves behavior therapies. These behavior therapies conceptualize TTM using operant learning theory and explain hair-pulling behavior as caused and maintained by environmental antecedents and consequences interacting with an individual’s biological makeup. This clinical case study describes use of an Acceptance and Commitment Therapy Enhanced Behavior Therapy for Trichotillomania (AEBT-T) protocol to facilitate treatment of a 20-year-old woman who was referred for TTM. The client remained in treatment for 14 months. After the completion of 32 therapy sessions, the client reported significantly reduced hair-pulling and anxiety, as well as increased engagement in valued activities. Implications of these findings are discussed, with an emphasis on the challenges of treating TTM in a college population.

Treating Trichotillomania

Trichotillomania (TTM) involves the compulsive pulling of one’s bodily hair and is often associated with significant distress or impairment. The present case study concerns a college-aged woman, whose history of TTM extended over 5 years and had been unsuccessfully treated by psychotherapy and medication management. Although TTM can be a challenging disorder to treat, the literature indicates that cognitive-behavioral therapy (CBT) has been successful in this regard. Therefore, we implemented CBT based on the manual developed by Keuthen, Stein, and Christenson; specific elements of therapy used included relaxation, self-monitoring, habit reversal training (HRT), reinforcement/punishment contingencies, thought monitoring, and cognitive restructuring. This approach was successful, as the client evidenced a 72% decrease in hair-pulling after using HRT alone, and complete elimination of hair-pulling after introducing the cognitive-restructuring element. Impressively, the gains lasted not only in the short term, but also had been reportedly maintained at a 5-year follow-up.