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Evidence for the successful use of psychotherapy in managing mental health disorders and symptoms like itch for patients with skin conditions is growing. This chapter introduces common non-pharmacologic therapies used to treat patients with psychocutaneous diseases. Specific therapeutic interventions like cognitive behavioral therapy, habit reversal training, mindfulness, biofeedback, and hypnosis are discussed.

Tourette syndrome and related tic disorders are complex, neuropsychiatric conditions that likely arise from fronto-subcortical circuit dysfunction. Individuals with these disorders often have additional neuropsychiatric comorbidities such as obsessive compulsive disorder and attention deficit hyperactivity disorder. Given their presumed overlapping genetic and neurodevelopmental origins, it is common for individuals to struggle with symptoms that overlap these diagnostic categories. As a result, careful attention must be paid to complete a thorough evaluation inclusive of these and other neuropsychiatric comorbidities, the presence of which helps to guide appropriate treatment, which includes specific psychotherapeutic and pharmacotherapeutic interventions for each of these disorders. This case of a young man exemplifies the complex and evolving experience of individuals struggling with Tourette syndrome and related disorders. His and his family’s stories provide a lesson in the natural history and diagnostic process of these neuropsychiatric conditions and serve as a starting point for discussion of neuropathological correlates and an in-depth discussion of pharmaco- and psychotherapeutic management.

Trichotillomania, or hair-pulling disorder, is characterized by the recurrent pulling out of one’s hair, leading to hair loss. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013), specifies additional diagnostic criteria for trichotillomania: (a) repeated attempts to reduce or stop hair pulling, (b) the hair pulling causes clinically significant distress or functional impairment, and (c) the hair pulling or hair loss is not due to a medical or other mental condition. Hair pulling can be observed in any region of the body, including the scalp, eyebrows, and axillary region.

Tourette syndrome (TS) is a childhood-onset, neurodevelopmental disorder that is diagnosed based on the presence of chronic motor and vocal tics. This chapter reviews the core clinical characteristic of tics and associated features including premonitory urges and contextual factors of tic expression. Co-occurring conditions including attention-deficit/hyperactivity disorder, anxiety disorders, and disruptive behavior disorders are common in children with TS. The chapter provides guidelines for diagnostic assessment of TS and co-occurring psychopathology as well as a review of psychometric measures of tic severity. Current research on neurobiological underpinnings of tics and pathophysiology of TS is also reviewed and linked to an overview of behavioral and psychopharmacological treatment approaches. Particular attention is dedicated to a behavioral intervention for tics known as habit reversal training (HRT) or comprehensive behavioral intervention for tics (CBIT). Recent research on clinical efficacy and moderators of response to CBIT is discussed and clinical recommendations for implementing CBIT for common tics are provided. Lastly, behavioral interventions for irritability and noncompliance that are common in children with TS are also reviewed and related to recommendations for comprehensive clinical care for individuals with TS.

Trichotillomania (TTM) is an impulse-control disorder characterized by the pulling of scalp, facial, and/or body hair, resulting in noticeable hair loss. It is associated with significant functional impairment, such as poor school and work performance, disruption in family functioning, and social impairment. This chapter will focus on adults with TTM through a review of the relevant research, an overview of the nature of the problem, and a description and assessment of a clinical case. A detailed treatment overview will follow, describing the use of habit reversal training (HRT) for reducing symptoms and improving functioning, along with a discussion of complicating factors. Finally, the chapter will highlight key practice points for clinicians treating adult TTM patients.