Hair-pulling can be associated with depressive symptoms and anxiety. While treatment is often elusive, some therapies have been found to be effective. This slideshow reviews noteworthy studies for clinicians to review.
Trichotillomania (TTM) may affect as many as 4% of the population with the highest incidence in childhood and adolescence. It can continue well into adulthood.Formerly considered an impulse control disorder (in DSM-IV), TTM is categorized in DSM-5 as an obsessive-compulsive and related disorder.1Diagnostic criteria include:
• Recurrent pulling out of hair, resulting in hair loss
• Repeated attempts to stop such behavior
• "Clinically significant” distress or impairment
• Not a result of a medical issue
• Not explained by other mental disordersThere are no FDA-approved medications for TTM, making treatment elusive-but the disorder can be effectively treated with behavioral and pharmacological therapies.Advance through the slideshow for "classic" and more current studies on the topic with links to respective research.Recommended reading: "Impulse Control Disorders: Clinical Characteristics and Pharmacological Management," by Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, and Suck Won Kim, MD.For a PDF of this slideshow, please click here.
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
Source: Swedo SE, Leonard HL, Rapoport JL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med. 1989;321:497-501. [link to study]
Source: Christenson GA, Mackenzie TB, Mitchell JE, Callies AL. A placebo-controlled, double-blind crossover trial of fluoxetine in trichotillomania. Am J Psychiatry. 1991;148:1566-1571. [link to study]
Source: O'Sullivan RL, Christenson GA, Stein DJ. Pharmacotherapy of trichotillomania. In: Stein DJ, Christenson GA, Hollander E, eds. Trichotillomania. Washington, DC: American Psychiatric Press, Inc; 1999:93-124.
Fluoxetine vs behavior therapy vs wait list
Source: van Minnen A, Hoogduin KAL, Keijsers GPJ, et al. Treatment of trichotillomania with behavioral therapy or fluoxetine. Arch Gen Psychiatry. 2003; 60:517-522. [link to study]
Also see: Fluoxetine
In this study, fluoxetine failed to show significant improvement when compared with placebo
Source: Streichenwein SM, Thornby JI. A long-term, double-blind, placebo-controlled crossover trial of the efficacy of fluoxetine for trichotillomania. Am J Psychiatry. 1995;152:1192-1196. [link to study]
Clomipramine or placebo vs behavior therapy
Source: Ninan PT, Rothbaum BO, Marsteller FA, et al. A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000;61:47-50. [link to study]
Also see: Cognitive behavioral therapy
Researchers found that CBT was a valid treatment for trichotillomania.
Source: Toledo EL et al. Group treatment for trichotillomania: cognitive-behavioral therapy versus supportive therapy. J Clin Psychiatry. 2015;76:447-455. [link to study]
Showed significant improvement on one of three measures compared with placebo.
Source: O'Sullivan RL, Christenson GA, Stein DJ. Pharmacotherapy of trichotillomania. In: Stein DJ, Christenson GA, Hollander E, eds. Trichotillomania. Washington, DC: American Psychiatric Press; Inc; 1999:93-124.
Failed to demonstrate significantly greater reductions in hair pulling compared to placebo.
Source: Grant JE, Odlaug BL, Schreiber LR, et al. The opiate antagonist, naltrexone, in the treatment of trichotillomania: results of a double-blind, placebo-controlled study. J Clin Psychopharmacol. 2014;34:134-138. [link to study]
Source: Van Ameringen M, Mancini C, Patterson B, et al. A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiatry. 2010;71:1336-1343. [link to study]
Significant improvement with N-acetyl cysteine when compared with placebo.
Source: Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009;66:756-663. [link to study]
No significant difference between N-acetylcysteine and placebo in children with trichotillomania.
Source: Bloch MH, Panza KE, Grant JE, et al. N-Acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-on trial. J Am Acad Child Adolesc Psychiatry. 2013;52:231-240. [link to study]