How to Help Someone With Trichotillomania

Someone with trichotillomania has uncontrollable impulses to pull their hair. Learn how to support a loved one with this disorder.

Trichotillomania is a mental health condition characterized by uncontrollable urges to pull out one’s hair. Approximately 1 percent of Americans will have trichotillomania in their lifetime. This disorder often leads to shame and embarrassment. This shame may increase once another person learns about the presence of the disorder. Inadvertently reinforcing these feelings of shame may lead to further social isolation.

Trichotillomania is more than a habit. It is the result of an overwhelming urge that may feel uncontrollable. Pulling hair is not a random occurrence in trichotillomania; instead, it is a behavior that generally follows specific patterns.

Before asking how to help someone with trichotillomania, learn about the disorder if you are unfamiliar with it. Ask questions instead of making assumptions; avoid judgment and practice empathy. Statements such as, “Just stop doing it,” or, “It’s just a bad habit,” are insensitive and unhelpful.

5 Ways to Help a Loved One With Trichotillomania

When your loved one is struggling with a problem, your natural impulse may be to jump in and help. However, it’s important to understand what types of help are most beneficial. Ultimately, remember that you (or another person) cannot fix your loved one’s trichotillomania, but there are ways that you can be supportive and encourage change.

1. Help identify patterns: Sometimes it is easier for a person on the outside looking in to observe behavioral patterns. Becoming aware of the factors that lead up to the hair pulling behaviors and actions that follow hair pulling can help bring clarity and insight for the person with trichotillomania. Your help in identifying patterns can also aid in identifying high-risk situations and triggers that can then either be avoided or coped with more effectively.

2. Help brainstorm coping skills and tools to help prevent hair pulling: For example, encourage your loved one to engage in a replacement behavior that still involves tactile stimulation, such as squeezing a stress ball, picking individual threads from a piece of fabric or using a fidget toy. If a person finds that the sensation at the root of their hair is what they would like to recreate or replace, they may find that using a mint shampoo, placing an icepack on the head, or combing hair may reduce the urge to pull.

3. Change environmental factors, if necessary: For example, if hair pulling typically occurs when viewing oneself in a magnifying mirror, it may be helpful to remove that mirror completely. If there are areas of the home where pulling occurs the most frequently, you could encourage your loved one to write and place written reminders to avoid these behaviors in those rooms.

4. Encourage healthier means to express and cope with difficult emotions: Finding healthy outlets for emotional expression may reduce the urge to pull. Someone may benefit from keeping a journal, exercising or practicing relaxation techniques. These behaviors can also aid in decreasing the symptoms of co-occurring mental health conditions like anxiety and depression. While anxiety and depression do not always co-occur with trichotillomania, many of the strategies used to soothe the symptoms of these disorders can also be useful for someone with trichotillomania.

5. Ask how you can be supportive: Although it may seem like the obvious first step, ask your loved one how they would like you to help them. Their idea of helpfulness might be different from what you see as helpful. For example, while it may seem helpful to call out pulling behaviors when they occur, this action should only be done if asked. Otherwise, it can lead to an increase in shame. Have a conversation with your loved one about when, where and how you can best offer support.

Tips on Helping Someone Find Help for Trichotillomania

Trichotillomania is commonly treated with a combination of psychotherapy, or talk therapy, and medication. The most common form of therapy or treatment for trichotillomania is cognitive behavioral therapy (CBT). Many mental health practitioners view CBT as the most effective treatment for this disorder. In CBT, your loved one can address the relationships between their thoughts, feelings and behaviors.

In addition, to talk therapy options and CBT, medication may also treat the symptoms of trichotillomania. However, specific medicines are typically used when a person struggles with a co-occurring mental health condition like an anxiety or depressive disorder.

Trichotillomania may be treated in either an inpatient or outpatient setting. The intensity of treatment may be influenced by whether other co-occurring disorders are present. For example, if there is a co-occurring drug or alcohol use disorder, inpatient treatment may be beneficial. If someone struggles with drug or alcohol addiction and trichotillomania — which is referred to as a dual diagnosis — it’s essential to treat both conditions at the same time. Lasting healing can begin when both disorders are addressed in inpatient or outpatient treatment.

Dual-diagnosis treatment that addresses substance abuse and mental health conditions simultaneously is offered at many rehab facilities across the country, including The Recovery Village.

Trichotillomania Support Groups

Like with many other conditions, there are support groups for trichotillomania. Speaking with others who have trichotillomania can help normalize the disorder and make your loved one feel less alone. Receiving support from someone at a trichotillomania support group can motivate your friend or family member to seek treatment for trichotillomania if they haven’t already.

Many cities have support groups for trichotillomania, though these are not always a part of a connected fellowship. Hair Pullers Anonymous is one peer support group available to people with trichotillomania. This group has weekly phone meetings.

Additional support groups can be found through The TLC Foundation for Body-Focused Repetitive Behaviors, which maintains a database of available support groups. This comprehensive online database can be filtered by state.

In addition to recommending support groups, you can further support your loved one by:

• Offering to drive them to trichotillomania support groups
• Attending a support group meeting with them, if they ask
• Offering to help them find a local mental health counselor to speak with
• Regularly asking how they’re doing in managing their condition
• Providing constant reassurance that their trichotillomania doesn’t define their personality

If you or a loved one has a drug or alcohol use disorder and is experiencing symptoms of trichotillomania, help is available. The Recovery Village treats substance abuse issues and co-occurring disorders simultaneously to promote lasting healing. Speak with a representative today to learn about options for substance abuse treatment and counseling for co-occurring trichotillomania. Calling is completely free and confidential, and you don’t have to commit to a program to learn more about treatment.

Editor – Camille Renzoni

Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more

Medically Reviewed By – Denise-Marie Griswold, LCAS

Denise-Marie Griswold is a Licensed Clinical Addictions Specialist. She earned her Master's Degree in Substance Abuse and Clinical Counseling from East Carolina University in 2014. Read more