Best Proven Trichotillomania Treatments: The Transtheoretical Model (6 Stages of change)

This is the most comprehensive guide that can help you to treat your hair-pulling disorder.

The best part?

I am going to show you ‘What are the causes and symptoms of TTM? & Possible Trichotillomania treatments & The Transtheoretical Model (Stages of change), that are helpful for you?

In short: If you want to get rid of TTM, you’ll love this guide.

Let’s get started.

What is trichotillomania?

Trichotillomania (Chronic hair pulling) is a very common disorder more common than we think. It is also called an impulse control disorder or an addictive disorder. Researchers also construct it as an obsessive-compulsive spectrum disorder.

Hair-pulling disorder (Trichotillomania) is the ability to pull their hair for the wood and these habits can affect up to four percent of the population. According to some studies it can be involved with stress, depression, excessive anxiety, and disorders. But in general, this is a disease that is four times more common in women.

Trichotillomania (TTM) impact is equal in males and females in adolescent years but it (TTM) can impact females more often in adulthood. It’s a habit that the person does alone sometimes they’re reading a book, watching tv, grooming in front of the mirror, or doing homework, and do not notice it but they are pulling their hair out.

It can happen in other regions of the body too. The problem with this is that the fact that you pull out and damage your scalp or skin will cause the follicle to die and no longer produce. Chronic hair pulling (TTM) mostly develops during childhood or adolescent years. One most important thing is that once Chronic hair pulling starts, it can continue for several years.

Have you seen those ladies who took their eyebrows a lot and left them very thin and now you notice that it doesn’t even grow anymore? The same thing that happens the fact that you keep pulling the hair a lot makes it thinner and weaker. Also, over time, it can cause thinning hair or bald spots.

Most commonly the symptoms of Trichotillomania (TTM) get worse during the time of pregnancy due to hormonal changes. There’s also a variant of this problem called trichophytic that’s the person in addition to pulling out the hair and ingesting the plaque strength and the strains.

It will stay in the stomach which can cause a syrup intestinal or stomach obstruction and this is a problem that needs surgery.


Trichotillomania Symptoms


Trichotillomania Symptoms
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There are many symptoms of TTM which include:

  • The first symptoms of TTM are that they repeatedly pull out their hair and it can lead to hair fall and significant distress.
  • The second symptoms of TTM are that they break off pieces of hair from their head or any other body part.
  • The third symptoms of TTM are that Perhaps after breaking off pieces of hair they can eat it. It (eating hair) is called trichophagy.
  • The fourth symptom of TTM is that they feel relieved after pulling out their hair.
  • The fifth symptom of TTM is that they feel an increasing sense of tension before pulling.
  • The sixth symptoms of TTM are that they face noticeable hair loss like bald areas, and hair thinning.
  • The seventh symptoms of TTM are that they play with pulled-out hair.
  • Eight symptoms of TTM are that they rubbing it across their lips or face.

Usually, TTM patients pull out hairs from some common areas like eyelashes, pubic hair, scalp, beards, and eyebrows.

In several years TTM patients may experience some side effects like skin irritations, bald spots, social anxiety, itching, and thinning hair.

Behavioral pattern

In TTM patients Priced pulling, like combing through the hair, feeling individual hair, tugging at hairs, and visually searching the scalp and hairline. Hairs may not be pulled at random but can be chosen based on specific characteristics.

  • Individuals with TTM commonly have post-pulling behavior that is also clinically relevant and idiosyncratic. In this stage, they feel stressed and uncomfortable. Because they have a habit or urge to pull hair.
  • Individuals with TTM commonly discard pulled hairs, others may play with the hair between their fingers. Also, they feel relaxed and feel relieved after doing this step. Also, they feel pleasure to do this.
  • Some people who have TTM may bite the hair between the teeth, or ingest all or parts of the hair. Which can lead to gastrointestinal injuries and symptoms like vomiting, abdominal pain, and nausea.


If gastrointestinal injuries are untreated then they can lead to acute pancreatitis, a perforated bowel, bowel obstruction, obstructive jaundice, and intestinal bleeding.


People who have TTM (Hair pulling disorder) experience some significant impact in adult age. TTM can cause deficits in occupational, psychological, academic, and social functioning.

People who have TTM (Hair pulling disorder) usually feel or experience negative effects and also negative self-evaluations including embarrassment, pain, isolation, low self-esteem, shame, pain, guilt, and unattractiveness.

Individuals with TTM commonly experience frustration and anger because they are unable to control their common hair-pulling habits. Sometimes they start taking tobacco or alcohol to decrease the negative feelings connected with the urges to pull.

Individuals with TTM always encounter lowered quality, frequency, and quantity of relationships, friendships, and dating. They always avoid visits to the hair salon or dresser due to the feeling of fear of exposure. Individuals with TTM commonly avoid social activities when their hair fall is noticeable.

People who are associated with TTM feel low self-esteem and fear that also can impact their occupational performances like difficulty with work productivity, career advancement, concentration, and academic performances like difficulty in studying, school absences, and school duties.

Researchers say that the impact of TTM is the same in both age groups children and adult age or the interferences of this disorder is the same in both age group. People who connected with TTM experience the feeling of guilt following a pulling episode, embarrassment due to the effects of pulling, and social avoidance.


  • Emotional Consequences: Many people told that pleasure while pulling, whereas others told that a reduction of aversive emotional states, such as anxiety, sadness, boredom, tension, or stress. However, an increase in some of those emotions, such as sadness or guilt, has been observed from during to post pulling.
  • Tactile Consequences: Tactile consequences involve reinforcement resulting from physical touch, Typically produced by the manipulation of pulled hair. Also, certain types of hair (coarse hair) may be targeted by an individual for pulling. Many people who are associated with TTM report engaging in post-pulling activities that produce physical sensations that function as reinforcers.
  • Visual Consequences: After the hair is pulled, the individual may engage in behaviors such as scanning the hair, looking at the root, looking at the thickness of the hair, or other visual behaviors. These behaviors likely produce visual stimulation that reinforces the pulling.
  • Cognitive Consequences: Cognitions associated with the emotional consequences discussed above may also result from pulling. For example, cognitions associated with sadness or guilt may assist in terminating a pulling episode.


Trichotillomania Causes

Researchers are not sure about the real causes of the hair-pulling disorder. But some external factors can trigger TTM like anxiety, stress, OCD, depression, ADHD, autism, anger, boredom, and shame.

But some other symptoms may be the cause of starting TTM like enjoying the feeling of the sensation of pulling the hair on the scalp, enjoying the feeling of the thickness of hair on their fingers.

Trichotillomania Treatment


No medications are approved by the administration for TTM. But when you see the doctor to treat TTM, the doctor may recommend you some medications like N-acetylcysteine (related to mood), Clomipramine (antidepressant), and Olanzapine (antipsychotic) to control certain symptoms of TTM.


Must Read:

Receding Hairline Treatment

Hair Loss Due to Stress and Anxiety?

Scalp Folliculitis Treatment


The Transtheoretical Model (Stages of change)

  • 1/ Precontemplation
  • 2/ Contemplation
  • 3/ Preparation/Determination
  • 4/ Action/Willpower
  • 5/ Maintenance
  • 6/ Termination
The transtheoretical model of health behavior change

The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination.

18 months

The first stage: Precontemplation

The first stage: Precontemplation

Techniques: Clarify: the decision is theirs. Explain and personalize the risk. Validate lack of readiness. Encourage self-exploration, not action. Encourage re-evaluation of current behavior.
Characteristics: Not currently considering change: “Ignorance is bliss“. In this stage, people who associate with TTM are not taking seriously or thinking seriously about changing themselves or changing their bad habits.
Also, at this stage, they are not focused or interested to take any kind of help to treat TTM. In this pre-contemplation stage, people may move or tend to guard or defend their present bad habit(s) and people are also not able to feel it is a problem. At this stage, TTM patients may be protecting or defensive in the face of other people’s attempts or efforts to invaluable or pressure them to quit.
In this stage, TTM patients are not interested to discuss their bad habits with others, and also they are not centered their awareness or attention on evacuating or quitting their bad habits. During the Precontemplation stage, people like to think that they are not having a problem.

The second stage: Contemplation

The second stage Contemplation

Techniques: Identify and promote new, positive outcome expectations. Validate lack of readiness. Encourage evaluation of the pros and cons of behavior change.
Clarify: the decision is theirs.
Characteristic: Not considering change within the next month.
Ambivalent about change: “sitting on the fence
In this stage, people who associate with TTM are more enlightened or aware of their bad habitsrepercussions or consequences. Also, they start spending time thinking about their problem or bad habits.
Although they can consider or observe the possibility or prospect of changing, they tend or move to be ambivalent or uncertain about it. In this contemplation stage, TTM patients are on a teeter-totter, weighing or contemplating the pros and cons of quitting their behavior or bad habits.
Although they can think about the negative aspects of their bad habits and the positive associated with giving them up. They may doubt that the long-term benefits associated with quitting will outweigh the short-term cost. It might take as little as a couple of weeks or as long as a lifetime to get through the contemplation stage.
On the plus side, people are more open to receiving information about their bad habits, and more likely to use educational interventions or interferences and reflect on their feelings and thoughts concerning their bad habits.

The third stage: Preparation/ Determination

The third stage Preparation Determination

Techniques: Help patient identify Social support. Encourage Small initial steps. Identify and assist in problem-solving regarding obstacles. Verify that patient has underlying skills for behavior change.
Characteristics: Planning to act within 1 month. Some experience with change and are trying to change: “Testing the waters“. In this stage, the TTM patient has made a dedication or commitment to change their bad habits or make a change in their behavior.
People are now taking small steps toward cessation. Also, they start gathering information about what they will need to do to change their bad habit. Too often, people skip this stage.

The fourth stage: Action

The fourth stage Action

Techniques: Combat feelings of loss and reiterate long-term benefits. Focus on restructuring cues and social support. Bolster self-efficacy for dealing with obstacles.
Characteristics: 3-6 months. Practicing new behavior. In this action stage of TTM, patients have self believe to change their bad habits or ability to change their behavior.
Also, People start involving (actively) themselves in taking steps to change their bad habits or behavior by using a variety of different techniques. In this action stage, TTM patients depend on their willpower.
TTM patients trying to make over and over efforts to change their bad habits. This is the shortest of all stages. Also, it can be as short as one hour. In this stage, TTM patient tends to be open to receiving help from other’s and TTM patient are also likely to seek support from others.

The fifth stage: Maintenance

The fifth stage Maintenance

Techniques: Discuss coping with relapse. Plan for follow-up support. Reinforce internal rewards.
Characteristics: Post-6 months to 5 years. Continued commitment to sustaining new behavior.
In this stage, the TTM patient involves maintenance to successfully avoid any temptations to return to the bad behavior or habit. The goal of this stage is to maintain the new status. In the maintenance stage, TTM patients move to remind themselves of how much progress they have made.
In this stage, TTM patients in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid replacement. Even though they may have thoughts of returning to their old habits, they resist the temptation and stay on track.
As they progress through their stages of change, it can be helpful to re-evaluate their progress in moving up and down through these stages.

The sixth stage: Termination

The sixth stage Termination

Individuals have zero temptation and they are sure they will not return to their old unhealthy habit as a way of coping. Achieving a long-term behavior change often requires ongoing support from family members, a health coach, Supportive literature, a physician, or another motivational source.

Behavioral therapy

  • 1/ Awareness Training: At this stage, TTM patients start identifying the environmental and psychological elements that can trip an event of TTM (Hair pulling ).
  • 2/ Competing response training: At this stage, the TTM patient exercises replacing the behavior of TTM ( Hair pulling) with another behavior.
  • 3/ Motivation and compliance: At this stage, TTM patient attracts to ventures that prompt them of the significance of thrust with HRT.
  • 4/ Relaxation Training: TTM patients want to reduce their stress related to hair pulling at this stage. That’s why they started practicing deep breathing and meditation.
  • 5/ Generalization training: At this stage, TTM patients start practicing their new skills in contrast affairs so that the new behavior becomes automatic.

13 Ways to Stop Polling Your Hair

  • 1/ Love yourself.
  • 2/ Tell your friends and family members to tell you to stop if they see you pulling.
  • 3/ Wear a rubber band around your wrist to snap every time you want to pull.
  • 4/ Wear a wig the entire day until you go to bed. Then put on a bandana.
  • 5/ Keep a journal of your feelings.
  • 6/ Help others, which in turn will help you.
  • 7/ Make yourself busy.
  • 8/ Have a positive attitude.
  • 9/ Brush your hair instead of pulling.
  • 10/ Wet down your hair.
  • 11/ Talk to another person with TTM.
  • 12/ Reward yourself after several days.
  • 13/ Be patient.


I hope this article can help you to understand and fight with TTM.

Ijaj Seikh

Hi, I Am Ijaj Seikh & Founder and CEO of MRIJAJGUIDE & FLPIS.

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