Therapy for
Trichotillomania & Dermatillomania
in San Francisco, CA

Trichotillomania (hair-pulling disorder) is a recognized mental health condition classified as an Obsessive-Compulsive Related Disorder in the DSM-5. Unlike a bad habit, trichotillomania involves recurrent, compulsive urges to pull hair from the scalp, eyebrows, eyelashes, or other areas — often resulting in noticeable hair loss and significant distress. The behavior typically serves a function (tension relief, sensory stimulation, emotional regulation) that makes it very difficult to stop through willpower alone. Professional treatment with evidence-based approaches like HRT and ComB is far more effective than self-directed attempts.

Dermatillomania (also called excoriation disorder or skin-picking disorder) is a body-focused repetitive behavior characterized by recurrent, compulsive picking of the skin — resulting in tissue damage, wounds, and scarring. Like trichotillomania, it is classified as an Obsessive-Compulsive Related Disorder and is driven by similar sensory, emotional, and cognitive mechanisms. Many people experience both conditions simultaneously, and the same evidence-based treatments — HRT, ComB, ACT — are effective for both.

The most evidence-based treatments for trichotillomania are Habit Reversal Training (HRT) and Comprehensive Behavioral Treatment (ComB). HRT teaches you to recognize the urge, identify your triggers, and replace the pulling response with a competing behavior. ComB goes further by systematically addressing the sensory, motor, cognitive, emotional, and environmental factors specific to your BFRB. At Bay Area CBT Center, our San Francisco trichotillomania therapists are trained in both approaches and will build a personalized treatment plan based on your unique profile.

Treatment length varies depending on the severity of the behavior, the presence of co-occurring conditions, and how long the BFRB has been present. Many clients see meaningful improvement within 8–16 sessions of focused behavioral treatment. More complex cases — particularly those with co-occurring OCD, anxiety, trauma, or ADHD — may benefit from longer-term work. We will give you a realistic timeline after your initial assessment.

Yes — online therapy for trichotillomania and dermatillomania is just as effective as in-person treatment. Research supports telehealth delivery of HRT and ComB, and our San Francisco BFRB therapists offer secure, HIPAA-compliant video sessions throughout California. Many clients prefer online therapy because it allows them to work in the environment where pulling or picking most often occurs — which can actually enhance treatment effectiveness.

Yes. BFRBs often begin in childhood or adolescence, and early intervention leads to better long-term outcomes. Our therapists are experienced in working with children, teens, and young adults with trichotillomania and dermatillomania, using age-appropriate adaptations of HRT and ComB. We also offer family involvement in treatment, which research shows improves outcomes for younger clients.

Trichotillomania and dermatillomania are classified in the OCD-related disorders category and share some features with OCD — including repetitive behaviors, difficulty resisting urges, and relief following the behavior. However, they are distinct conditions with their own treatment protocols. Many people with BFRBs also have co-occurring anxiety, OCD, ADHD, or depression, and our therapists are trained to address all of these simultaneously within an integrated treatment plan.

The easiest way to get started is to schedule a free 20-minute consultation. During this call, you will speak with one of our therapists, describe what you are experiencing, and get a sense of whether our approach is a good fit. From there, we will schedule an initial assessment and begin building your personalized treatment plan. You can book online or call us at 415-941-5373.