Skin picking and hair pulling disorders in children and adolescents: The role of cognitive behavior therapy

Skin picking and hair pulling disorders are psychopathological conditions characterized respectively by repetitive picking behaviors and pulling out of hair, which result in significant tissue damage and hair loss, accompanied by marked distress. Although symptoms may first appear in various age groups, onset is often observed in adolescence coinciding with the onset of signs of puberty, the average age of onset is reported to be between 12 and 16 years. Skin picking and hair pulling disorders often present in comorbidity and have in common several clinical features such as age of onset, gender distribution, trigger situations, dysfunctional cognitions, difficulty in stopping repetitive behavior, presence of impulsivity, and difficulty in emotional regulation. Therefore, a psychotherapeutic approach aimed to target the vulnerability and maintenance factors of both disorders may be a useful strategy. An increasingly large amount of data suggest that cognitive behavioral therapy is an effective psychological treatment for these conditions. It comprises behavioral components including habit reversal training and cognitive strategies (i.e., cognitive restructuring), and it may be combined with third-wave psychotherapeutic approaches such as Acceptance & Commitment Therapy. The present chapter focuses on the empirical data about the effectiveness of cognitive behavioral interventions for skin picking and hair pulling disorders, particularly in children and adolescents. The practical application of the cognitive behavioral techniques to clinical practice with youth who have these conditions is described.