What are the barriers to treatment for Trichotillomania?  

Carol Novak, M.D. (1997),  the founder of the Pioneer Clinic in Minnesota and an expert in trichotillomania, gave insights on barriers to recovery from hair pulling.  These barriers are problems for those who get immobilized or blocked at partial success, or who seem to "back slide" from progress they have made.  

First, there is the barrier of denial: not seeing the problem, or seeming to lack motivation. Such a lack of motivation, she says, can be a mask for complex feelings, including feelings of hopelessness. They might minimize the impact of "trich" on their life.

Secondly, the person may lack faith that they can get better.  This can be a result of professionals or friends telling them to "just stop," as though that were possible.

Third, the "trickster" can be angry that they have been given this affliction. Acceptance of the condition is necessary eventually, in order to get better.  

Fourth, the sufferer needs to be ready for the work of recovery; that is, the person needs to have the time and ability to concentrate on recovery.  

It is also possible that other psychological issues can interfere with recovery and need to be dealth with.  And teenagers can rebel against parents by refusing behavior strategies, even though these strategies might be good for their recovery.  

Additionally, the sufferer may be so accustomed to pulling and seeing herself as a trichster, that she may have a hard time adjusting to a change in identity.