Tourette and Trichotillomania: Adapting Treatment While Maintaining Fidelity

Document Type

Contribution to Book

Publication Date



Oxford University Press

Source Publication

Flexibility Within Fidelity

Source ISSN


Original Item ID

DOI: 10.1093/med-psych/9780197552155.003.0014


This chapter explores the treatment of trichotillomania (TTM; also referred to as hair pulling disorder) and Tourette disorder (TD). TTM and TD exist in separate diagnostic categories but exhibit functional similarities and respond to similar treatments. The chapter reviews the characteristics of each disorder. It then describes habit reversal training (HRT) and function-based interventions, which serve as core therapeutic elements in the treatment of both TTM and TD. The chapter also discusses additional treatment strategies that occur as part of standard protocols for both disorders, before looking at the treatment efficacy research. It considers the key features of the manual-based treatments (behavior therapy protocols), as well as ways these protocols can be flexibly implemented for those with TTM and TD. Finally, consistent with the call for “flexibility within fidelity,” the chapter provides an example of a flexible implementation of these treatments.


"Tourette and Trichotillomania: Adapting Treatment While Maintaining Fidelity" in Flexibility Within Fidelity. Ed. Philip C. Kendall. New York: Oxford University Press, 2022: 260-294. DOI.