Trichotillomania Therapists in North Vancouver, BC

What is trichotillomania?

Trichotillomania is a body-focused repetitive behaviour (BFRB) characterized by recurrent, compulsive urges to pull out hair from the scalp, eyebrows, eyelashes, or other areas of the body. It is classified in the DSM-5 alongside OCD and related disorders. Many people with trichotillomania experience significant shame and hide the behaviour, which is why it is thought to be more common than reported. It affects approximately 1–2% of the population and can begin at any age, with peaks in early childhood and adolescence.

What causes trichotillomania?

The exact cause is not fully understood, but trichotillomania is associated with difficulties in emotional regulation — hair pulling typically provides relief from tension, anxiety, boredom, or emotional pain, and is reinforced by the temporary sense of calm it produces. Neurological factors, genetics, and co-occurring anxiety or depression are also relevant. Understanding the specific function hair pulling serves for you individually is a key part of effective treatment.

What therapy approaches are most effective for trichotillomania?

Habit Reversal Training (HRT) has the strongest evidence base for trichotillomania and other BFRBs. HRT involves increasing awareness of pulling triggers and urges, and substituting a competing behaviour. The Comprehensive Behavioural Treatment model (ComB) builds on HRT by addressing sensory, motor, emotional, cognitive, and environmental factors. ACT is also used to help people change their relationship to urges without acting on them. Many therapists combine approaches for the best outcomes.

Is trichotillomania related to OCD?

Trichotillomania is in the same DSM-5 diagnostic category as OCD (obsessive-compulsive and related disorders), and the two share some features — notably repetitive behaviours that relieve distress. However, they differ in important ways: OCD involves obsessions (intrusive, unwanted thoughts) that drive compulsions, while trichotillomania is driven more by urges and sensory tension without the same intrusive thought pattern. Treatment approaches also differ — exposure and response prevention (the primary OCD treatment) is less central in trichotillomania treatment than HRT and ComB.

How long does trichotillomania treatment take?

Many people see meaningful reduction in hair pulling within 8–12 sessions with a therapist trained in HRT or ComB. Some people achieve significant control more quickly; others with long-standing pulling patterns or complex co-occurring conditions benefit from longer treatment. Relapse is common, particularly during stressful periods, and booster sessions can help maintain gains. Finding a therapist specifically trained in BFRBs is important — general CBT without the specific BFRB protocol is less effective.