by Tim Brunson, PhD
Trichotillomania, which is also referred to as trich or TTM, is an impulse control disorder, which involves recurrent hair pulling, resulting in a noticeable loss of hair. It includes compulsive and habitual pulling of eye lashes, eye brows, head hair, and pubic hair. Tension before the act and feelings of pleasure immediately thereafter are typical affect conditions. The obvious hair loss results in increased anxiety and often may lead to an avoidance of social situations and even intimate relationships. Reduced self-esteem is also a factor. Hypnotherapy is a valid clinical intervention for trich treatment.
The pervasiveness of trich is unknown. One study indicated that 11% of surveyed college students reported symptoms. 92 to 93% of sufferers are female. Scalp hair puling (80%) is the most prevalent form of trich. This is followed by lash pulling (46%) and brow pulling (43.5%).
Although trich's onset normally occurs during the teen years, it may start as early as the pre-teen period. Many younger patients eventually outgrow it. However, if they do not, it will last until their adult years. Too many medical doctors ignore young trich patients as they frequently believe that they will eventually outgrow it. This popular belief may prevent the patient from receiving adequate treatment during the period when it may be best resolved.
Trich is frequently believed to be an obsessive-compulsive disorder (OCD). Therefore, there is a belief that it can respond to serotonin reuptake blockers. Nevertheless, there are important differences between trich and OCD. The term trichotillomania was formally incorporated into DSM-III (Diagnostical and Statistical Manual of Mental Disorders) in 1987. It is still classified as an impulse-control disorder much like pyromania, kleptomania, and pathological gambling.
Considering the many comorbid affect conditions may be the key to truly understanding trich and designing hypnotherapeutic interventions. Hair pulling often occurs in sedentary and contemplative situations while the patient is sitting or lying down and absorbed in thought or concentrating on other tasks. Therefore, their acting out is often out of their awareness or in only partial awareness. Also, tension, boredom, anger, depression, frustration, indecision, lethargy, and fatigue states are also frequently occurring.
Trichotillomania is a learned behavior that is programmed into the patient's brain during a period in their life when that organ does not have sufficient neo-cortical resources to understand and deal with threats. Therefore, it is somewhat of a defensive reaction that is programmed (i.e. habituated). Should the patient not grow out of it, the resulting neural networks become so strong that they tend to resist any type of intervention.
The psychotherapeutic treatment of trich must address empowerment, self-efficacy, the development of dissociative awareness, and habit replacement. Essentially, they must develop the belief that they can change, awareness of hair pulling incidents, and replace their self-image and habitual behavior. The re-focusing of their mind can help the neural networks associated with the malady to wither and strengthen new pathways.
Hypnotherapy is uniquely suited as an intervention for the treatment of trichotillomania. This is for two primary reasons. First, the essential nature of hypnosis is to bypass resistance to change. This is often referred to as a bypass of pattern resistance, a bypass of the critical faculty, or splitting the symptoms from the cause. However, the primary fact here is that once a trich sufferer becomes an adult, the associated neural patterns are extremely strong and, like any entrenched patterns, they will resist any efforts to change.
The second benefit of the therapeutic use of hypnosis is that it has the ability to create alternate neural pathways. Posthypnotic suggestions that a hair pulling incident trigger a dissociated awareness are extremely helpful, as the patient will automatically become aware and potentially able to find alternate behaviors. Additionally, hypnosis can be used to install new behaviors, to establish and reinforce the patient's belief that they have the power to alter affect responses, and to establish a more empowering self-image. Guided imagery, direct and indirect suggestions, parallel communication, and humor are among the variety of techniques available to a competent hypnotherapist.
With the use of hypnotherapy, it is important for the clinician to realize that treatment is not a short-term solution. A trich hypnotherapy protocol should include several weekly or bi-weekly sessions with the clinician. These sessions should sequentially focus on self-efficacy/empowerment, dissociative awareness, establishing alternate responses, and reinforcing new self-imagery. These sessions should be aided by having the patient listen daily to self-hypnosis recordings that either focus on the specific topic of the previous visit or a multi-topic audio, which is specifically designed to address trich.
Trichotillomania is a very resistive mental pathology. Symptom-based treatment is ineffective in the long-run. Solution-based treatment attacks the underlying entrenched neural patterns and attempts to establish alternate ones. Although there are many psychotherapeutic avenues that may show significantly positive results, hypnotherapy appears to be the best suited.
The International Hypnosis Research Institute is a member supported project involving integrative health care specialists from around the world. We provide information and educational resources to clinicians. Dr. Brunson is the author of over 150 self-help and clinical CD's and MP3's.