Trichtillomania and Chronic Skin Picking
"Trichotillomania (TTM) is a disorder that causes people to pull out the hair from their scalp, eyelashes, eyebrows, pubic area, underarms, beard, chest, legs or other parts of the body, resulting in noticeable bald patches. Hair pulling varies greatly in its severity, location on the body, and response to treatment. For some people, at some times, trichotillomania is mild and can be quelled with a bit of extra awareness and concentration. For others, at times the urge may be so strong that it makes thinking of anything else nearly impossible."

"Pathologic Skin Picking (PSP), also known as Dermatillomania, is a serious and poorly understood problem. People who suffer from PSP repetitively touch, rub, scratch, pick at, or dig into their skin, often in an attempt to remove small irregularities or perceived imperfections. This behavior may result in skin discoloration or scarring. In more serious cases, severe tissue damage and visible disfigurement can result.

PSP is now thought of as one of many Body-Focused Repetitive Behaviors (BFRBs) in which a person can cause harm or damage to themselves or their appearance. Other BFRBs include chronic hair pulling (trichotillomania), biting the insides of the cheeks, and severe nail biting."

While it is estimated that two to four percent of people have BFRBs, they remain grossly under studied.  Many to most of the more recent studies have been performed by members of the Trichotillomania Learning Center (TLC) and/or received financial support from TLC.

HIGHLY RECOMMENDED is Free Webinar by Martin Franklin, PhD.  It is VERY informative about what is known about TTM and CSP and treatment.  If you have these conditions or you have a family member with them, take 75 minutes for the presentation.  You won't be sorry. 
You probably will have to download codec (computer code) at for your media player to work.

Treatment Options:

The main treatment is Cognitive-Behavioral Therapy (CBT).  Several behavioral techniques (a subset of CBT), Habit Reversal (HRT) and Stimulus Control were first studied in the 1970's and are almost always a part of the treatment package.  Increasing one's awareness is critical, as well as maintaining a commitment to not pull.  Becoming more aware where one performs the compulsive behaviors, as well as what emotional states one is frequently in during the behaviors is extremely important.  Knowing where may help you minimize your time in that environment as well as being more aware when in those environments.  Knowing what emotional state triggers these behaviors can help develop strategies to minimize those states, ex. Stress, as well as to develop alternative strategies when one is in those states of mind.

CBT has been shown to be helpful not only in adults, but in 2010, a study was published that adapted techniques are also effective with children down to the age of 7.

There are no rigorous studies that have proven that any medication to be effective with TTM and CSP.  Most often, anti-depressant medications are used and are very helpful to some with these behaviors.  That is not to say that these medications have not proven to be helpful for many with anxiety and/or depression.  Some evidence suggests that those anti-depressants that raise levels of both serotonin and norepenephrine (SSNRIs), such as Effexor, may work better than those that raise only one.   An excellent article on medications is Medications for Trichotillomania and Pathologic Skin Picking by Jon Grant, MD.

Grant's article also briefly touches on the promising use of N-Acetyl Cysteine (NAC), an amino acid and Inositol, a B-vitamin and an isomer of glucose.  For more information and a brief video on Grant's research on  NAC1  and  NAC2.   NAC can be obtained at Vitamin Stores, GNC, or online.  Most to all of the people that I know who have taken it report that it is helpful.  Interestingly, I don't think I know anyone who has taken the doses that have been studied.

A study published in 2009 showed 56% of adults who took NAC reported significant benefit.  There is currently an ongoing study at Yale treating children and teens with TTM with NAC.  The initial results (VERY small sample, so far) are similar to the adult study.  A study at Yale with children and teens has NOT shown NAC to be helpful to them.


A great article written by
Sherrie Vavrichek, LCSW and Ruth Goldfinger Golomb, MEd is posted on, both leaders in the field.  Be sure to check it out.

There are a handful or so books written for people with these conditions.  One good one is Help for Hair Pullers by Kuethen, Stein, and Christenson.  A book I really like for parents and older kids is The Hair Pulling "habit and You. How to Solve the Trichotillomania Puzzle.  By Ruth Golomb and Sherrie Vavrichek.  Another excellent book for parents is Stay Out of My Hair by Mouton-Odum and Golomb.

Some have found using my  Weekly Trich & Pick Busters Checklist
  to begin or add to your recovery.  Here are additional Trichotillomania and Chronic Skin Picking Resources.  For additional information on these topics, got to the Trichotillomania Learning Center (TLC).


Many don't have access to trained providers or find individual sessions to be out of their budget should consider (hair pulling) or (skin picking).  These are paid interactive sites ($29.95/mo.) and were developed by Dr. Suzanne Mouton-Odum,  Dr. Nancy Keuthen, and Dr. Allison Jones Stocker, all leading experts on these topics.  A study is underway to measure it's effectiveness

If are unable to find or afford a therapist with special training with trichotillomania or dermatillomania, there are support groups in many areas TLC Support Groups, as well as online support groups TLC Online Resources.

DON'T GIVE UP!  More is being learned all the time in finding more effective treatments.

Adult Group Therapy for Chronic Hair Pulling and Chronic Skin Picking

STOP Picking on Yourself!

I regret that I no longer am co-facilitating the therapy group, due to lack of clients.  However, Karen Tomoff, LPCC continues the ongoing bi-weekly group specifically for adults with either Trichotillomania (compulsive hair pulling) or Dermatillomania (pathologic skin picking).  The group meets in Rocky River on Tuesdays at 7:10 PM.

Contact me for individual/family treatment or Karen for more information about the group (440) 781-7484.

                     Copyright 2008 - 2012.   Michael Miller.   All rights reserved.

Phone:  (216) 520-5969
Fax:      (216) 520-5098

6133 Rockside Rd.
Suite 207
Independence, OH  44131

30400 Detroit Rd. 
Suite 301
Westlake, OH  44145
Michael L. Miller, PhD, LICDC  Psychologist

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