Hypnosis as a Vehicle for Choice and Self-Agency in the Treatment of Children with Trichotillomania

Abstract

Three pediatric cases of Trichotillomania were treated with direct hypnotic suggestion with exclusive emphasis on sensitizing and alerting the patients to impending scalp hair pulling behaviors. These children had presented with total lack of awareness of their scalp hair pulling behaviors until they had actually twisted and pulled off clumps of hair. It was also suggested, under hypnosis, that upon learning to recognize impending scalp hair pulling behaviors, the patients would become free to choose to willfully pull their hair or to resist the impulse and not pull. At no point was the explicit suggestion given that they stop pulling their hair. A preliminary condition was agreed to by the parents that redefined the patients' hair as their own property and affirmed their sole responsibility for its care and maintenance. An element of secondary gain was identified in each of these cases. Scalp hair pulling was hypothesized to provide these particular patients with a vehicle with which to oppose their overbearing and over-involved parents. The technique of direct suggestion under hypnosis, aimed at alerting the patients to impending scalp hair pulling behaviors was combined with forming contracts with the parents to relinquish their authority over matters regarding the patients' hair. This combination provided an effective treatment that extinguished the scalp hair pulling in 7 visits or less. These cases received follow-up at intervals up to 6 months and no evidence of relapse was found.

Alternative Medicine for Hair Loss

“…Even if just a recurrence was observed in one patient during follow-up, the patient completely recovered again with hypnotic retreatment [123]. Iglesias A observed that three pediatric cases completely disappeared to their trichotillomania behavior after 7 or less hypnotic sessions [124]. In addition to children, hair pulling was significantly reduced with imaginative techniques in adolescents with trichotillomania [125].…”

Pediatric trichotillomania: Review of management

“…Alternative behavioral intervention approaches, such as hypnotherapy, have been utilized to sensitize and alert patients to impending pulling behaviors. Case series of solo hypnotherapy have demonstrated complete or near‐complete resolutions of TTM in children with low relapse rates that should encourage further investigation of this treatment modality . Cases of solo hypnotherapy in adolescents and adults are limited and show mixed results, likely due to the increased prevalence of comorbid psychiatric conditions in this age group .…”

“…Case series of solo hypnotherapy have demonstrated complete or near-complete resolutions of TTM in children with low relapse rates that should encourage further investigation of this treatment modality. 20,21 Cases of solo hypnotherapy in adolescents and adults are limited and show mixed results, likely due to the increased prevalence of comorbid psychiatric conditions in this age group. 20,22 The lack of controlled trails of hypnotherapy makes it difficult to ascertain the true efficacy of this therapy.…”

Practitioner Review: Clinical applications of pediatric hypnosis

“…Research has demonstrated successful treatment of trichotillomania with hypnosis (Cohen, Barzilai, & Lahat, 1999; Iglesias, 2003; Kohen, 1996). Kohen (1996) reported successful management of trichotillomania among 5 children, aged 3–15 years, who were taught self‐monitoring, dissociative hypnotic techniques, self‐hypnosis, and RMI.…”

“…In an additional study, 3 children, aged 8–11 years, were exposed to several 30‐minute sessions of direct hypnotic suggestions to assist them in growing more aware of the earliest movement associated with their hair‐pulling behavior (Iglesias, 2003). Hair pulling ceased after 6 sessions on average and there were no relapses at 6‐month follow‐up.…”