Psychotherapeutic: Trichotillomania is treated primarily through behavioral therapy. Cognitive behavioral therapy (CBT), which helps children become more aware of their hair pulling, is very helpful. Through a form of CBT called habit reversal therapy, children are taught to recognize the emotions and triggers involved in their hair pulling. Sometimes something as simple as wearing loud, dangling bracelets can make kids more self-aware. When they feel the urge, they learn to substitute another motion or activity instead.
Some doctors recommend tricks that make hair pulling more difficult. For example, wearing bandages around the fingers and nails can make it harder to pull out hair, as does wearing hair pulled back or under a hat. For kids who enjoy the sensation of playing with the hair after it has been pulled, rolling a paper clip or playing with a textured pencil topper can help re-create the desired sensation and keep the hands distracted. Some kids in treatment carry kits around with bandages, paper clips, hair ties and other items that will help them.
For focused pulling in particular, the treatment includes the cognitive work of changing the way the person responds to negative emotions. Teaching them better coping skills for the distress, and helping them tolerate negative emotions without pulling, will help them achieve the goal of maintaining their hair.
Pharmacological: Medication is usually not the first choice in treating trichotillomania, although children may be prescribed antidepressants like SSRIs while they participate in behavioral therapy.