Hypnotherapy for hair pulling (trichotillomania)

Are you losing hair because you compulsively pull your hair? Do you have a sense that you must remove any hairs that aren't "right" (eg too coarse, wrong colour)? Do you have bald patches on your scalp, in your eyebrows or eyelashes? Does your hair pulling take up a lot of time and energy? Have you tried to use willpower to stop, but not managed it? Do you do your hair or cover it specifically to hide the impact of pulling? Do you feel alone and ashamed, that you have to keep your hair pulling a secret?

We specialise in hypnotherapy for Body Focused Repetitive Behaviours (BFRBs) like hair pulling (trichotillomania), skin picking (dermatillomania), nail biting (onychophagia) and thumb sucking. Sian is a Professional Member of The TLC Foundation for Body Focused Repetitive Behaviours, and has completed their professional training for treatment of BFRBs.

What is hair pulling?

Hair pulling (trichotillomania) is one of a set of body focussed repetitive behaviours (BFRBs) on the Obssessive Compulsive Spectrum. Previously hair pulling was categorised as an Impulse Control Disorder, but since the publication of the DSM V in May 2013, it has been designated a Body Focused Repetitive Behaviour, alongside skin picking (dermatillomania), nail biting (onychopagia) and thumb sucking, and other BFRBs. BFRBs are three times more common than anorexia, with a prevalence of between 1-4% in the general population.

Typically, people with BFRBs will regularly engage in repetitive self-grooming habits that end up damaging their bodies, for example, pulling, picking, biting or scraping of the hair, skin or nails. In trichotillomania, hair loss is caused by compulsive pulling out of body hair (eg scalp, eyebrows, eyelashes, pubic area; beard or chest in men). It is important to note that the intention is to remove perceived imperfection or self-soothe, so hair pulling is not about self-harm - any damage is a by-product of attempts to get rid of imperfections or self soothe.

In addition to the physical impact of hair pulling, people often also experience a sense of shame and isolation, frustration, anxiety and low self-esteem related to the behaviour. This often creates a vicious cycle, as the hair pulling has a negative effect on relationships, work and overall quality of life, which often leads to more hair pulling to alleviate the uncomfortable feelings being experienced.

Research conducted at the University of Montreal in March 2015 indicates that some character traits may predispose individuals to developing a BFRB. These include being easily frustrated and impatient, and high levels of perfectionism.

While there are instances of people who have started pulling their hair much earlier than adolescence, most people who pull their hair (or engage in other BFRBs) start between the ages of 11 and 13. It tends to occur more frequently in women, but this may be due to that fact that men tend to under-report health issues. Over time, hair pulling often features cycles of varying severity.

Symptoms of hair pulling (trichotillomania)

Hair pulling can happen when a person is awake and aware of what they're doing, frequently resulting in highly focussed pulling sessions that can last several hours. Hair pulling also occurs when a person is unaware, or focussed on something else; for example, when watching TV, reading, using a computer or phone. It can also happen when people are asleep. Often the experience of hair pulling is pleasurable or satisfying as a person does it, making it more challenging to change the behaviour.

Hair pulling follows the classic negative cycle: generally, an urge to pull arises, caused by a trigger (obvious/not, internal/external). The trigger can be active (eg grooming behaviour such as scanning for imperfection/difference) or just a sensation (tingling, itching) that occurs on the scalp or in the hands. Attempts at resistance are made, followed by giving in and pulling until reaching a point of satiation, which may take minutes or hours.

Afterwards, immediate feelings of satisfaction and relief start to give way to a strong awareness of the damage done, along with feelings of failure, shame, self-criticism, anxiety and being out of control, and resolution to not pull again. These negative reactions lead to uncomfortable feelings, which often triggers more hair pulling.

There is currently no established cause, but contributing factors include stress, anxiety, genetic pre-disposition and difficulties with impulse control (eg impatience, frustration, perfectionism).The result can be bald patches, skin/follicle infections, and sometimes permanent hair loss. The physical effects are often made signicantly worse by the psychological impact of reduced confidence and self-esteem (including envy and jealousy), shame, isolation, anxiety, depression and frustration.

How hypnotherapy can help hair pulling (trichotillomania)

When pulling their hair, individuals often show many of the characteristics of being in trance. Their attention is narrowly focused, they are powerfully engaged with the activity using all senses and time may seem to disappear. And all this is often triggered by a powerful suggestion/cue that has been built and reinforced over time when in this trance-like state. So, in many ways, people who pull their hair already have a lot of experience of going into trance and using it to reinforce behaviour and its benefits - they just need a bit of help to turn that power in a positive direction.

Hypnotherapy is very effective for hair pulling (and other BFRBs), as it can help you regain control, increase your awareness and ability to choose more beneficial responses. The hypnotic trance is also good for deep relaxation, so your stress and anxiety levels are reduced, which in turn makes it less likely that you'll want to pull your hair.

In the deeply relaxed state of hypnosis, your subconscious is more receptive to revising thoughts and actions, so you can:

• increase your awareness of how your hair pulling operates, especially increasing awareness of your hands
• regain control of your focus, so you can tolerate thoughts and urges more readily and consistently
• create and rehearse a new, personalised response that is incompatible with hair pulling
• identify trigger situations and people, and rehearse using your new response in these situations
• increase your calm, confidence and relaxation, so the need for hair pulling is reduced
• develop a "stop at one" response in case you do start to pull
• build a robust, personalised plan for dealing with any relapses quickly and constructively
• learn how to use self-hypnosis as a direct substitute for hair pulling, as appropriate
• safely and easily identify and work with any past events that may be contributing to your hair pulling

And when your hair starts to grow back, hypnotherapy can also help you deepen the determination, confidence and patience to meet the challenges that are features of this part of the healing process, such as letting new hair growth be and being at ease with how your hair looks (eg if regrowth is uneven, if you decided to wear a wig or shave your head).

Hypnotherapy can also help you reduce any tendency to compare yourself unfavourably with others, keeping going even if you do pull again, and begin to feel more comfortable with letting your hair get on with doing its job. In addition, if there is a past experience that is contributing to your hair pulling, the hypnotic state allows you to safely and easily work with that experience, so it no longer fuels the urge to pull your hair.

For more information about hypnotherapy for hair pulling (trichotillomania), or to book an appointment, contact Sian on 07725 732810 or email.

...I can honestly say my sessions with Sian have changed my life. I have not rubbed my eyebrow at all since my first session (it has now grown back) and we progressed to addressing other habits, particularly picking my skin...
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...I found the sessions very useful, as I'm much more relaxed now and pulling my hair less and less. I was very nervous beforehand, but you put me at ease straight away. I have to say I was pleasantly surprised at the results: I feel more in control, my scalp is looking much better, and I even have some new hair growing back!...
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...when I booked my first hypnotherapy session I was sceptical that I could break many years of habit in just a few sessions as other forms of therapy had failed before. Sian seemed to really listen and understand my concerns. I was able to benefit very quickly from our sessions which addressed my hair pulling and nail biting habits by providing practical solutions. I feel a lot more hopeful about the future...
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