Dallas CBT psychologists specialize in treatment for Trichotillomania (TTM) and other body-focused repetitive behaviors (for example, skin-picking) in children and adults. It is not uncommon for individuals to develop certain repetitive behaviors, such as twirling their hair, clicking their tongue, or biting their nails or cheek. Most of the time, these behaviors are innocuous or nothing more than a habit. Sometimes, however, these repetitive behaviors become more extreme or severe. Trichotillomania, or hair pulling disorder, involves strong and repeated urges to pull or twist hair until it breaks or comes loose, and can often result in significant hair loss. There are many different reasons and ways that people pull hair, and these urges might occur with or without awareness. Likewise, hair might be pulled from anywhere on the body, such as scalp, eyebrows, eyelashes, underarm hair, arm and leg hair, pubic hair, or beard. Those struggling with trichotillomania may find it very difficult to stop, even when there are significant personal or social consequences to this behavior, such as noticeable bald spots. Trichotillomania can develop at any point in the lifespan, even in children ages 0 to 5.

Potential Signs of Trichotillomania

  • Finding yourself pulling hair throughout the day such as during class, watching TV, or falling asleep
  • Difficulty stopping hair pulling
  • Preoccupation with the way a hair looks or feels
  • Having to find ways to cover up hair loss, such as with makeup or wearing hats or wigs


Hair pulling in Trichotillomania is a part of an established behavioral pattern that is learned or reinforced over time, and, as such, this behavior can also be changed or “un-learned.” Though this can be difficult for individuals to do on their own, there are good therapeutic options available. Treatment at Dallas CBT is based on the Comprehensive Behavioral Model (ComB), a state-of-the-art, effective therapy option for trichotillomania.

The ComB treatment approach involves identifying cues for hair pulling, such as settings, activities, or emotional states, and the functions that pulling serves for the individual. During treatment, therapists will help clients increase awareness of their behaviors and urges, identify important contributors to the behavior, evaluate the function of the behavior, and work on developing a set of alternative strategies uniquely tailored to each client. Therapy will teach individuals to modify problematic thoughts and feelings contributing to hair pulling behaviors and find healthy alternatives to address the functions that pulling serves. For children struggling with hair pulling, specific time will be spent in helping the parents understand the disorder and improving their ability to aid their child in management of this behavior. Over time with therapy, urges to pull will become weaker and easier to manage.

In therapy, you can expect to:
  • Increase awareness of behaviors and urges
  • Identify important factors influencing behavior
  • Understand the function of hair pulling
  • Develop a set of alternative strategies to reduce pulling