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Treatment Plans


Discover our multidisciplinary, integrated, and individualized therapies for the treatment of Trichotillomania: Neuromodulation Therapies, Pharmacological Therapy, Psychotherapy, and Individual and Family Psychoeducation.

Trichotillomania ― Symptoms and Characteristics

Trichotillomania is an Obsessive-Compulsive Spectrum disorder which manifests itself through the recurrent pulling out of hair. This disorder, often related to Obsessive-Compulsive Disorder (OCD), can involve any area of the body covered by hair, but the most commonly affected areas include the scalp, eyebrows, and eyelashes. Nevertheless, body regions can vary from individual to individual and also include the axillary areas, facial region, and pubic and peri-rectal areas. In addition, the areas of concern may change over time.

The essential characteristic of Trichotillomania is the inability to resist the urge to pull out hair, which may occur during frequent short daily episodes or less frequently but over longer periods of time, extending even over months or years. Although hair pulling is typically spread out so that the loss is not visible (e.g., a single hair per scalp area), it often happens that the symptoms are so severe that the behavior's consequences are widely visible. In such cases, those suffering from the disorder may attempt to hide the loss of hair through the use of makeup, scarves, or wigs so that the areas affected by the pulling behavior are less visible.

Trichotillomania can cause significant distress, including feelings of shame and embarrassment, and can lead to a level of disability that affects a person's social, school, work and other important areas of functioning. Often, those who struggle with this disorder make several attempts to stop or reduce the pulling behavior and enact avoidance behaviors in different public situations precisely because of the discomfort the disorder creates. In addition, it is common for the act of pulling out hair or hair to occur in solitude, except when close family members are present.

Trichotillomania may also involve a range of hair-related behaviors or rituals, such as:

  • The search for specific hair to be pulled out (e.g., of a certain color or specific texture);

  • A specific way of pulling out the hair (e.g., keeping the root of the hair/hair intact);

  • A visual/tactile analysis or handling of the hair after its removal (e.g., examining it by passing it between the teeth, rotating it between the fingers, or breaking it into two parts).

The symptoms may be preceded or accompanied by various emotional states. In fact, the pulling behavior may be triggered by states of anxiety or boredom or be preceded by a growing sense of tension. Once the hair has been pulled out, this is usually associated with a sense of pleasure or relief. For this reason, Trichotillomania is often considered a form of Behavioral Addiction and often this specific aspect of gratification may also involve other areas of behavior besides hair pulling.

Furthermore, Trichotillomania can vary in the degree of awareness of the person suffering from it: the pulling behavior can range from being a totally conscious behavior to a completely automatic act. In this regard, most patients exhibit a mix of both behavioral styles.

Finally, some individuals with Trichotillomania may experience the urge to pull hair from other people, animals, or objects (e.g., sweaters or carpets). In addition, the disorder is often associated with other body-focused repetitive behaviors, such as excoriation (dermatillomania) or onychophagy.

Trichotillomania ― Diagnosis and Treatment

At Dr. Stefano Pallanti's Istituto di Neuroscienze, we treat Trichotillomania with a highly personalized diagnosis and treatment method aimed at improving the quality of life of our patients.

① DIAGNOSIS AND ASSESSMENT ― The first step in this process is a thorough careful Diagnosis and Assessment procedure, which includes the use of targeted interviews to establish an accurate differential diagnosis.

② ASSESSMENT OF COMORBIDITIES ― During the assessment process, we perform a comprehensive evaluation of comorbidities, which includes the careful analysis of psychopathological, endocrinological, food intolerances, lifestyle, and parmacological intolerances factors. This in-depth assessment enables us to achieve a complete understanding of each patient's clinical picture and develop an individualized treatment plan.

③ DEFINITION OF RESISTANCE DEGREE AND NEW THERAPY ― Once we have all the necessary information, we define the disorder's degree of resistance to treatment. This helps us determine the most appropriate treatment approach for the individual patient.

Dr. Stefano Pallanti's Istituto di Neuroscienze offers comprehensive support for the treatment of Trichotillomania that starts with a Precision Diagnosis and culminates in targeted, individualized therapies to help patients regain control over their impulses and improve their quality of life.

Trichotillomania ― Available Therapies

Dr. Stefano Pallanti's Istituto di Neuroscienze employs a comprehensive and innovative approach to the treatment of Trichotillomania that integrates different treatment modalities with the aim of providing the best possible care for those suffering from this disorder.

➜ Prominent among the therapies used within our Treatment Plan are Neuromodulation Therapies, particularly Transcranial Magnetic Stimulation (TMS) and Transcranial Direct-Current Stimulation (tDCS). Through these cutting-edge treatments, we are able to modulate brain activity related to Trichotillomania symptoms, helping to reduce hair-pulling behaviors.

➜ In addition to Neuromodulation Therapies, our treatment approach includes the possibility of integrating an individualized and targeted Pharmacological Therapy, which can represent a valuable compotent for the treatment of some patients. When well selected and dosed, medications can provide important help in being able to regulate the impulses of Trichotillomania and improve behavioral control.

Psychotherapy represents another key pillar of our approach. More specifically, we employ Cognitive Behavioral Therapy (CBT) interventions, an evidence-based psychotherapy approach that has been shown to be effective in treating Trichotillomania. Through psychotherapy interventions, we help our patients identify and manage their thoughts, emotions, and behaviors associated with Trichotillomania.

➜ In addition, we recognize the importance of family support in the success of a treatment path. For this reason, we offer family support interviews to engage the person's support network within their recovery from Trichotillomania.

Dr. Pallanti's Credentials

Dr. Pallanti is one of the leading experts on OCD in the world.

He is a Board Member of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS, UK) and for the European College of Neuropsychopharmacology (ECNP), Dr. Pallanti serves in several roles: Executive Committee Member (2016 – 2019), Obsessive-Compulsive and Related Disorders Network Member, Scientific Committee Board Member, Scientific Advisory Panel Member for Anxiety, Chair of the ECNP Neuromodulation Thematic Working Group.

From 2005 to 2007, Dr. Pallanti has held the positions of Member of the OCD Spectrum Workgroup, the Impulse Control Disorders Taskforce and the International Advisory Board of the American Psychiatric Association (APA) for DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; Chair D.J. Kupfer).