Therapy | Trichotillomania from scratching the skin (2023)

CBT is one of four psychotherapy procedures approved by health insurers. This means that KBT is covered by health insurance companies if it is performed by licensed psychotherapists.

Until now, studies on dermatillomania and trichotillomania have been done almost exclusively with this form of therapy. As many of the studies point to the effectiveness of behavioral interventions in these disorders (see below), CBT is currently the method of choice.

In general, there is still a great need for research here!

Detailed general information about CBT can be found elsewhere (cf.connections).

For derma and trichotillomania, CBT includes the following elements, among others:

ACT isNOan independent therapy method recognized by health insurance companies. However, some therapists have gained an additional qualification from the ACT.

ACT focuses on accepting, not avoiding, certain experiences and feelings. For example, skin working/hair pulling can be used to relieve or try to avoid tension.
This approach is primarily about dealing with distressing feelings and experiences with acceptance. At the same time, the alignment of one's own life with personal values ​​and goals is valued.
Initial studies show good results for ACT in dermatillomania and trichotillomania; however, combinations of behavioral therapy and ACT interventions have been studied in some cases.
In general, there are more or better studies on the effectiveness of ACT in trichotillomania than in dermatillomania.

The same applies to DBTNOan independent therapy method recognized by health insurance companies. However, many therapists have completed DBT training!
DBT is a therapeutic approach originally developed for self-injurious behavior. The main focus is on the topics of stress and emotion regulation, which also play a role in dermatillomania and trichotillomania.

So far, one study has reported promising results for a combination of CBT and DBT in trichotillomania (see below Keuthen et al., 2012). However, further studies are still pending.

In addition to the therapeutic approaches described above, there are of course other psychotherapeutic treatment options.
In addition to behavioral therapy, health insurance companies allow the following additional therapy methods as so-called psychotherapeutic counseling methods:

1. Psychotherapy based on depth psychology
2. Psychoanalysis
3. Systemic therapy

In addition to the procedures in the psychotherapy guidelines, many other therapy or coaching approaches are offered (eg art therapy, body therapy, hypnosis) that you can use independently.

The security and quality of the respective offers must be verified on a case-by-case basis. The seriousness and quality of the offers are very different! Anyone wishing to take advantage of this offer should pay particular attention to transparency regarding the person's qualifications: What training did you complete? What professional associations are you a member of? To what extent does the person have professional experience in this area?
The less information about the rating, the more dubious!

Important to know:
Studies on the effectiveness of dermatillomania and trichotillomania are only available for the above mentioned therapy methods (CBT (+HRT), DBT, ACT).

Currently, there are very few psychotherapists who (eg on their homepage) explicitly mention BFRB as a treatment approach; this is particularly true for dermatillomania, as this diagnosis is even more recent than trichotillomania. Unfortunately, dermatillomania is still relatively unknown, often even among psychotherapists. But the disorder is getting more and more attention and more and more therapists are aware of it!

For both disorders, it makes sense to seek out therapists who specialize in “dermatillomania”, “trichotillomania” or “obsessive-compulsive and related disorders”. If you don't find anyone with these priorities nearby who might offer you a date, and it's quite likely, don't be discouraged.
Of course it is an advantage if you already have some prior knowledge on the subject of dermatillomania or trichotillomania, but in general psychotherapy is also about finding a solution together! Furthermore, many of the contents, strategies, and exercises in psychotherapy are similar for different disorders.
In the initial in-person consultation (and subsequent trial sessions) you will have a good feeling that you are on the same wavelength as the therapist and that you can envision the therapy there. This criterion is much more important for choosing a therapist than a specific procedure!