Cognitive-Behavioral Treatment of Trichotillomania, Targeting Perfectionism

Abstract

Trichotillomania or hair pulling has been considered mainly as a tensionreducing habit. However, other cognitive, emotional, and situational factors have been identified as important in the development andmaintenance of this disorder. The present case study applied habit reversal techniques, with the addition of a cognitive modification of perfectionist beliefs and style of action, in the treatment of a 23-year-old woman. During an 18-week period, her hair-pulling behavior decreased from a mean of 24 hairs pulled each day to 1 hair pulled overall in a week. A 1.5-year follow-up showed that the client suffered a small relapse during a period of 2 weeks. A self-imposed return to cognitive and behavioral techniques eliminated further pulling. This single case report raises the possibility that perfectionismmay be an important target for cognitive-behavioral treatment intervention in habit disorders such as trichotillomania.