Hypnotherapy for Hair Pulling and Skin Picking

Hair pulling (trichotillomania) and skin picking (excoriation disorder) are body-focused repetitive behaviors; the Association for Behavioral and Cognitive Therapies estimates that hair pulling disorder affects up to 4 percent of people. The first-line treatment is cognitive behavioral, built on habit reversal. Hypnosis can support that work by helping you notice the urge and rehearse what to do instead, but it is not a substitute for it.

What are these conditions?

ABCT describes trichotillomania as repeated, non-cosmetic removal of hair that causes distress or problems in daily life, despite repeated attempts to stop. People may pull with little awareness, often during sedentary activities, or in response to uncomfortable emotions or sensations.

The Wikipedia article on excoriation disorder describes repeated urges to pick at one’s own skin to the point of physical or psychological harm, and places it on the obsessive-compulsive spectrum. Complications can include infection and tissue damage. The article also notes that feelings of helplessness, guilt and shame can raise the risk of self-harm, and that people with it often do not seek treatment, largely because of embarrassment, lack of awareness or the belief that it cannot be treated.

What treatment works?

ABCT describes habit reversal therapy combined with stimulus control as the core approach, with consistent support in research trials. A typical course involves:

1. Understanding your triggers: the situations, moods and sensations that come before pulling or picking.
2. Developing a competing response you can do instead.
3. Enlisting a support person to encourage the alternative.
4. Stimulus control: reducing triggers and making the behavior harder, such as getting rid of tweezers, covering vulnerable areas with bandages or hats, and giving your hands something else to do.

ABCT adds that approaches such as acceptance and commitment therapy and dialectical behavior therapy may improve results by helping people tolerate and regulate the feelings that drive the behavior. Medication research is limited; discuss any medication with your doctor.

What can hypnosis add to habit reversal for pulling and picking?

At the steps that depend on awareness and rehearsal:

• Noticing: picturing your high-risk moments, such as the mirror, the sofa or a screen, and noticing the hand moving before it reaches hair or skin.
• Switching: rehearsing your competing response until it comes easily.
• Tolerating the urge: practicing a short calming routine to ride out the uncomfortable feeling without acting on it.

This is a reasonable use of hypnosis within habit reversal, not a tested alternative to it.

When do you need medical help?

See a doctor if skin picking has caused wounds that look infected, if hair loss is significant, or if the behavior is tied to low mood or intense shame. Some pulling or picking can be part of other conditions, such as OCD or a skin condition, so an assessment matters. If you have thoughts of harming yourself, call or text 988 in the United States to reach the Suicide and Crisis Lifeline. Outside the United States, contact your local emergency number or crisis line.

A plan to start with

1. Keep a log for two weeks: when, where, what you were doing and feeling.
2. Choose one competing response and one stimulus-control change.
3. Rehearse noticing and switching in a short self-hypnosis routine each day.
4. Tell one support person what you are working on.
5. Look for a therapist trained in habit reversal if the log does not improve within a month.

This article is general information, not medical or psychological advice; talk with a licensed clinician about your own situation.