How to Manage Trichotillomania (Hair-Pulling Disorder)

In this episode of The Tyranny of Hope, West Breedlove takes a closer look at trichotillomania, also known as hair-pulling disorder—a condition marked by the overwhelming urge to pull out one’s hair. This behavior can lead to visible hair loss, distress, and feelings of isolation. To offer hope and practical support, we explore the Comprehensive Behavioral (ComB) model for treatment, as developed by Dr. Charles Mansueto and his team (Mansueto, Golomb, Thomas, & Stemberger, 1999). This model is widely recognized for its individualized approach, helping people understand and manage the patterns that drive their hair-pulling. Throughout the episode, we break down each phase of the ComB model, beginning with assessment and functional analysis to identify personal triggers and cues. We also discuss the five modalities that influence hair-pulling behavior—cognitive, affective, motoric, sensory, and environmental—and introduce strategies for each. Listeners will learn about interventions such as cognitive restructuring, sensory alternatives, and motor-awareness techniques that empower individuals to reduce the urge to pull. Whether you’re personally impacted by trichotillomania or supporting someone who is, this episode provides evidence-based insights and tools to foster resilience, self-awareness, and a path forward in managing this challenging condition. Sources for Further Reading: 1.Mansueto, C.S., Golomb, R.G., Thomas, A.M., & Stemberger, R.M.T. (1999). A Comprehensive Model for Behavioral Treatment of Trichotillomania. Cognitive and Behavioral Practice, 6(1), 23-43. 2.Trichotillomania Learning Center. (2023). Trichotillomania Fact Sheet. Retrieved from https://www.bfrb.org 3.Stein, D.J., Grant, J.E., Franklin, M.E., et al. (2010). Trichotillomania (hair-pulling disorder), skin-picking disorder, and stereotypic movement disorder. World Psychiatry, 9(3), 150–155.