Behavioral interventions for trichotillomania

Trichotillomania (TCM) is a disorder characterized by chronic hair pulling. The initial conceptualization of TCM as a severe psychiatric disturbance (Hallopeau, 1889), guided treatment of the disorder for many decades and remains relatively common today. It was not until the 1970's that this notion was challenged with a behavioral approach. The behavioral approach to treating hair pulling focused on environmental influences and used empirically derived principles of behavior as the foundation for clinical interventions. This paper will provide a review of the behavioral treatments found effective in treating hair pulling, as well as a brief synopsis of the literature behind the medical management of TCM. Overall, literature on the treatment of TCM has been highly variable with respect to clinical presentation and prognosis. This variability can make interpretation of the research difficult and confusing. The current psychiatric literature characterizes TCM as a complex psychopathological disorder that is relatively resistant to treatment (see Graber & Arndt, 1993), whereas behavioral researchers tend to conceptualize TCM as a habit, without reference to an underlying psychopathology (Friman, Finney, & Christophersen, 1984). It has been suggested that the divergent treatment outcomes and conceptualizations reported across disciplines reflect different subject populations, with the more severe cases represented in the psychiatric literature (Friman et al., 1984). Although this theory remains untested, the self-selection of subjects to different treatment facilities cannot be ignored.