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At least 19 recordsLinked to original sources
PubMed2000

Trichotillomania: a challenge to research and practice.

This review explores several aspects of trichotillomania relevant to clinical theory and practice. It is concluded that research outlining the phenomenology and patterns of comorbidity of trichotillomania have been advanced significantly in recent years. However, no current diagnostic category appropriately classifies trichotillomania. Research with nonclinical populations suggests that trichotillomania is more common than previously believed and that additional epidemiological research is warranted. Continued elaboration of existing etiological models incorporating varying theoretical perspectives is also encouraged. Assessment of trichotillomania could also be improved by the continued development of reliable and valid standardized measures. This article reviews both pharmacological and psychological treatments for trichotillomania, with an emphasis on habit-reversal training. Though some interventions appear effective in the short-term, reported relapse rates are high and future research on treatment for trichotillomania should focus on improving long-term outcomes. It is clear that despite a recent flux of research centering on trichotillomania, significant challenges for understanding and treating this psychological disorder still exist for researchers and clinicians. Based on this review of the literature, and on our clinical experience with trichotillomania, we propose directions for future research with this underserved psychiatric group.

Diagnosis, Differential↗
PubMed2000

A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania.

BACKGROUND: The major treatments reported to be effective in the treatment of trichotillomania are cognitive-behavioral therapy (CBT) with habit reversal and serotonin-norepinephrine reuptake inhibitors such as clomipramine. However, the 2 treatments have not been previously compared with each other. This study examines the efficacy of CBT and clomipramine compared with placebo in the treatment of trichotillomania. METHOD: Twenty-three patients with trichotillomania as determined by the Structured Clinical Interview for DSM-III-R entered and 16 completed a 9-week, placebo-controlled, randomized, parallel-treatment study of CBT and clomipramine. Efficacy was evaluated by the Trichotillomania Severity Scale, the Trichotillomania Impairment Scale, and the Clinical Global Impressions-Improvement scale, which were conducted by an independent assessor blinded to the treatment condition. RESULTS: CBT had a dramatic effect in reducing symptoms of trichotillomania and was significantly more effective than clomipramine (p = .016) or placebo (p = .026). Clomipramine resulted in symptom reduction greater than that with placebo, but the difference fell short of statistical significance. Placebo response was minimal. CONCLUSION: Clinicians should be aware of the potential treatments available for trichotillomania. A larger and more definitive study comparing CBT and a serotonin-norepinephrine reuptake inhibitor is indicated.

Adult↗
PubMed2006

A neuropsychological comparison of obsessive-compulsive disorder and trichotillomania.

BACKGROUND: Obsessive-compulsive disorder (OCD) and trichotillomania (compulsive hair-pulling) share overlapping co-morbidity, familial transmission, and phenomenology. However, the extent to which these disorders share a common cognitive phenotype has yet to be elucidated using patients without confounding co-morbidities. AIM: To compare neurocognitive functioning in co-morbidity-free patients with OCD and trichotillomania, focusing on domains of learning and memory, executive function, affective processing, reflection-impulsivity and decision-making. METHOD: Twenty patients with OCD, 20 patients with trichotillomania, and 20 matched controls undertook neuropsychological assessment after meeting stringent inclusion criteria. RESULTS: Groups were matched for age, education, verbal IQ, and gender. The OCD and trichotillomania groups were impaired on spatial working memory. Only OCD patients showed additional impairments on executive planning and visual pattern recognition memory, and missed more responses to sad target words than other groups on an affective go/no-go task. Furthermore, OCD patients failed to modulate their behaviour between conditions on the reflection-impulsivity test, suggestive of cognitive inflexibility. Both clinical groups showed intact decision-making and probabilistic reversal learning. CONCLUSIONS: OCD and trichotillomania shared overlapping spatial working memory problems, but neuropsychological dysfunction in OCD spanned additional domains that were intact in trichotillomania. Findings are discussed in relation to likely fronto-striatal neural substrates and future research directions.

Adult↗
PubMed1999

The potential role of haloperidol in the treatment of trichotillomania.

BACKGROUND: Trichotillomania is categorized as an impulse control disorder in DSM-IV and is considered by some to be closely related to Obsessive Compulsive Disorder (OCD). We review the clinical phenomenology and pharmacological response of trichotillomania, and suggest that it may be more related to Tourette Syndrome than to OCD. Serotonin reuptake inhibitors (SRIs) are typically employed in the treatment of OCD, while neuroleptic medications such as haloperidol are typically used in the treatment of Tourette Syndrome. Evidence for the efficacy of treatment of trichotillomania with drugs typically used for OCD is equivocal. METHOD: Nine patients with trichotillomania were treated with haloperidol. Six patients unresponsive to SSRI medication had haloperidol added to their treatment. Three patients received only haloperidol. Response to treatment was assessed using descriptions of hair pulling, quantity of hair pulled, and severity of depilation at hair pulling sites. RESULTS: Eight of nine patients responded to haloperidol treatment, with seven experiencing complete or near complete cessation of hair pulling. LIMITATIONS: Inferences from the results of this study are limited by the lack of a control group, the small sample size, and the use of unstandardized ratings as measures of symptom severity. CONCLUSIONS: Results suggest that the addition of haloperidol to SSRIs or haloperidol alone may be effective in the treatment of trichotillomania. Results also encourage speculation about the relation between OCD, Tourette Syndrome, and trichotillomania.

Adult↗
PubMed2006

Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania.

OBJECTIVE: Problems with inhibiting certain pathological behaviors are integral to obsessive-compulsive disorder (OCD), trichotillomania, and other putative obsessive-compulsive spectrum disorders. The authors assessed and compared motor inhibition and cognitive flexibility in OCD and trichotillomania for the first time, to their knowledge. METHOD: The Stop-Signal Task and the Intradimensiona/Extradimensional Shift Task were administered to 20 patients with OCD, 17 patients with trichotillomania, and 20 healthy comparison subjects. RESULTS: Both OCD and trichotillomania showed impaired inhibition of motor responses. For trichotillomania, the deficit was worse than for OCD, and the degree of the deficit correlated significantly with symptom severity. Only patients with OCD showed deficits in cognitive flexibility. CONCLUSIONS: Impaired inhibition of motor responses (impulsivity) was found in OCD and trichotillomania, whereas cognitive inflexibility (thought to contribute to compulsivity) was limited to OCD. This assessment will advance the characterization and classification of obsessive-compulsive spectrum disorders and aid the development of novel treatments.

Adult↗
PubMed2006

Single modality versus dual modality treatment for trichotillomania: sertraline, behavioral therapy, or both?

BACKGROUND: Trichotillomania is a psychiatric condition characterized by chronic hair pulling. Both cognitive behavioral therapy (CBT) and the selective serotonin reuptake inhibitors (SSRIs) have shown promise in the treatment of trichotillomania, with comparison studies favoring CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the efficacy of individual SSRI or CBT treatment to the combination of both treatment modalities. METHOD: In this study, which ran from February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were randomly assigned to treatment with sertraline or placebo in a double-blind study design. Following 12 weeks of active pharmacotherapy, subjects not demonstrating significant trichotillomania symptom improvement had habit reversal training (HRT) added to their treatment regimen. Primary outcome measures were the Hair Pulling Scale and the Clinical Global Impressions scale. RESULTS: Thirteen subjects completing the 22-week study received single modality treatment of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania symptoms in both groups improved, although the dual modality treatment group demonstrated larger gains and were much more likely to reach responder status at final evaluation. CONCLUSION: These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.

Adult↗
PubMed1996

Trichotillomania in connection with alopecia areata.

Alopecia areata and trichotillomania present the most frequent causes of circumscribed hair loss in children. The connection between trichotillomania and alopecia areata has confused former observers. It may result from scratching at the site of alopecia areata that is symptomatic with pruritus, initiating a habit-forming behavior, or patients with a mental predisposition may artificially prolong the disfigurement as the hair on the bald patches of alopecia areata regrows. We have seen the concomitant occurrence of trichotillomania and alopecia areata in a 13-year-old boy, and confirmed the diagnosis by results of histopathologic examination. With regard to pathogenesis and prognosis, the differentiation of trichotillomania in connection with alopecia areata from the more common patterns of temporary localized childhood trichotillomania and severe adult trichotillomania is suggested.

Adolescent↗
PubMed2003

Treatment of trichotillomania with behavioral therapy or fluoxetine: a randomized, waiting-list controlled study.

BACKGROUND: Both behavioral therapy (BT) and serotonin reuptake inhibitors have been reported effective in the treatment of trichotillomania. This study examines the efficacy of BT and fluoxetine hydrochloride compared with a waiting-list (WL) control group. METHODS: Forty-three patients with trichotillomania entered a 12-week randomized, WL-controlled study of BT and fluoxetine (60 mg/d). Forty patients (14 in the BT group, 11 in the fluoxetine group, and 15 in the WL group) completed the trial. Treatment effects were evaluated using the Massachusetts General Hospital Hairpulling Scale, and severity of hair loss was rated by independent assessors. In addition, we measured general symptoms of psychopathologic abnormalities and depression. RESULTS: For reducing the symptoms of trichotillomania, BT was superior. Patients in the BT group showed a significantly greater reduction in trichotillomania symptoms, higher effect sizes (Massachusetts General Hospital Hairpulling Scale: BT, 3.80; fluoxetine, 0.42; and WL, 1.09), and more clinically significant changes (BT, 64%; fluoxetine, 9%; and WL, 20%) than patients in the fluoxetine and WL groups. For severity of hair loss, a similar trend was also found in favor of the BT group. No significant differences between groups were established for general psychopathologic and depressive symptoms. CONCLUSIONS: Behavioral therapy is highly effective for reducing symptoms of trichotillomania in the short term, whereas fluoxetine is not.

Adolescent↗
PubMed2002

Trichotillomania and skin-picking: a phenomenological comparison.

Although trichotillomania and pathological skin-picking are both characterized by repetitive self-injurious stereotypic behaviors, the former is classified as an impulse control disorder, while the latter is not given a specific diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) [APA, 1994]. There are, however, few empirical data on phenomenological similarities and differences between these disorders. Patients with trichotillomania and pathological skin-picking were compared in terms of several demographic (age, gender), clinical (comorbid axis I and II disorders), and personality variables. Trichotillomania and pathological skin-picking were very similar in demographics, psychiatric comorbidity, and personality dimensions. Dissociative symptoms may be more common in trichotillomania than in pathological skin-picking. These data support the concept of phenomenological overlap between trichotillomania and pathological skin-picking. Future work to assess the implications of overlap for clinical evaluation and intervention in the two conditions may be useful.

Adult↗
PubMed1997

Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania.

Previous trials of selective serotonin reuptake inhibitors (SSRIs) in the treatment of trichotillomania have provided conflicting data. Furthermore, the efficacy of citalopram, the most selective of the SSRIs, in trichotillomania has not previously been documented. Citalopram was used on an open-label naturalistic basis in 14 (1 male and 13 females) patients who presented with chronic hair-pulling and met DSM-IV criteria for trichotillomania. Ratings were completed every 2 weeks for 12 weeks, during which time dosage was increased to a maximum of 60 mg daily (mean dose 36.2 +/- 13.9 mg). One patient was unable to tolerate citalopram. In completers, ratings on each of the scales employed were significantly improved after treatment. Of completers 38.5% were responders (Clinical Global Impressions score of 2 or less) at week 12. Citalopram appears to be safe in trichotillomania, and it may be effective in a subset of patients. Given the relatively low response rate, however, a controlled trial is needed before this agent can be said to be more effective than placebo. The pharmacotherapy of trichotillomania deserves further study.

Adult↗
PubMed2000

Conceptual issues in trichotillomania, a prototypical impulse control disorder.

Impulse control disorders (ICDs) are characterized by irresistible urges to perform acts that result in a reduction of tension and possibly gratification, but also have negative consequences. Trichotillomania, an ICD, is characterized by a recurrent failure to resist impulses to pull out one's hair, resulting in noticeable hair loss. Limited information is available about structural and neurochemical differences in individuals with trichotillomania. Cognitive behavioral techniques are promising treatments for trichotillomania. Pharmacologic treatments have focussed on clomipramine and venlafaxine as potentially effective for the short term control of symptoms in trichotillomania. Selective serotonin reuptake inhibitors, though promising in open trials, seem to be largely ineffective in reducing hair pulling in controlled studies. Durability of pharmacologic benefit for the symptoms of trichotillomania, both in a small trial and in clinical experience, appears to be poor.

Adult↗
PubMed2002

Functional brain imaging and pharmacotherapy in trichotillomania. Single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram.

The neurobiology and pharmacotherapy of trichotillomania has received increasing attention in recent years. Parallels have been drawn between findings in this disorder and those in obsessive-compulsive disorder (OCD). To date, however, there has been little work on the effect of a pharmacotherapeutic intervention on functional brain imaging in trichotillomania. Female patients (n = 10) with DMS-IV diagnostic criteria for trichotillomania were subjected to single photon emission computed tomography (SPECT) with technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) before and after 12 weeks of pharmacotherapy with the selective serotonin reuptake inhibitor (SSRI), citalopram. Pharmacotherapy led to significantly reduced activity in inferior-posterior and other frontal regions. Correlates of hair-pulling symptoms with regional brain activity differed before and after pharmacotherapy. These data are to some extent consistent with work suggesting that trichotillomania, like OCD, is mediated by corticostriatal circuits. Pharmacotherapeutic response to SSRIs in trichotillomania may not be as robust as in OCD. Further research is necessary to determine the neurobiological underpinnings of these differences.

Adult↗
PubMedDate not supplied

Psychosocial issues for women with trichotillomania.

Trichotillomania, the compulsive urge to pull out one's hair, is a poorly studied chronic condition affecting 2 to 8 million people, 90% of whom are women. Significant gains have been made about the nature and clinical presentation of this disorder, and yet conceptualizations of trichotillomania remain inconsistent and controversial. Consequently, treatments for trichotillomania have proven to be largely ineffective. Anecdotal case studies have provided us with preliminary data about the impact of this condition on emotional, psychological, and social well-being. To date, there are no empirical studies that focus on patients' subjective experiences with their disorder. The purpose of this report is to identify and discuss the concerns of women with trichotillomania. We have also provided clinical examples to highlight how these concerns are evident in the lives of these women. A total of seven women participated in focused interviews which asked them to reflect on their experiences with compulsive hair pulling. The interview transcripts were analyzed for themes using techniques from the constant comparative method. Additionally, women were asked to complete a demographic self-report. Our analysis identified themes pertinent to negative affects, control, and triggering precipitants. We argue that identifying and integrating these themes in current treatment protocols is the first step to improving the efficacy of treatment for trichotillomania.

Adolescent↗
PubMed2006

Investigating healthcare providers' knowledge of trichotillomania and its treatment.

Given the low prevalence rate and rather secretive nature of trichotillomania, it is uncertain how much trichotillomania-related knowledge physicians and psychologists possess, what the perceived role of a psychologist is in the treatment process, what level of familiarity practitioners have with effective treatments and whether providers have resource materials available for patients. In a postal survey of 501 psychologists and physicians in the USA, providers responded correctly to 61% of the general knowledge items about trichotillomania. Most providers believed that psychologists may play a variety of roles in the clinical management of the disorder. Although providers were fairly accurate about the effectiveness of certain treatments for trichotillomania (e.g. medication, habit-reversal), a number of non-empirically supported treatments were endorsed as being effective. Furthermore, an overwhelming majority of healthcare providers did not have resources or referral information available for patients with trichotillomania. Implications of the findings and limitations of the study are discussed.

Attitude of Health Personnel↗
PubMed1993

Elimination of thumb-sucking as a treatment for severe trichotillomania.

A 5-year-old girl presented with a 3-year history of severe trichotillomania and alopecia. The trichotillomania was observed to covary, or occur only in the presence of thumb-sucking. Thus, the elimination of thumb-sucking was targeted as a treatment for trichotillomania. The investigation evaluated the relative effectiveness of a standard aversive taste treatment, a response-dependent alarm and a response-disrupting thumb-post. Results indicated that only the thumb-post completely eliminated thumb-sucking and the covarying trichotillomania. These results suggest that when trichotillomania is a benign habit disorder, the treatment of a covarying habit such as thumb-sucking can be an effective treatment alternative and that resilient thumb-sucking can be effectively managed with an easily implemented thumb-post that requires little supervision and provides long-term success.

Aversive Therapy↗
PubMed1995

Childhood trichotillomania: clinical phenomenology, comorbidity, and family genetics.

OBJECTIVE: DSM-IV defines trichotillomania as an impulse disorder with rising tension followed by relief or gratification. Alternative formulations view trichotillomania as an internalizing disorder or variant of obsessive-compulsive disorder (OCD). This study addresses this controversy by examining the phenomenology, comorbidity, and family genetics of childhood trichotillomania. METHOD: Fifteen chronic hair-pullers (13 girls), aged 9 through 17 years (mean 12.3 +/- 2.3 years), were systematically assessed. Child Behavior Checklist (CBCL) profiles of the hair-pulling girls were compared with those of 37 girls from a general child psychiatry clinic and of 15 girls with OCD. RESULTS: All the hair-pullers had impairing cosmetic disfigurement; however, 4 subjects (26.7%) denied rising tension or relief. All three groups had comparable global CBCL problem scores. The CBCL symptom profile of the hair-pulling group differed significantly from that of the general clinic group but strongly resembled that of the OCD group. The hair-pulling group, however, had few obsessions or compulsions aside from hair-pulling; two (13%) subjects met criteria for OCD. As a group, hair-pulling subjects had substantial comorbid psychopathology, and a parental history of tics, habits, or obsessive-compulsive symptoms was common. CONCLUSIONS: These findings lend only partial support to the notion of trichotillomania as an OCD-spectrum disorder. Rising tension followed by relief or gratification may not be an appropriate diagnostic criterion for trichotillomania.

Adolescent↗
PubMed2007

Escitalopram treatment of trichotillomania.

With the understanding that serotonergic drugs might curb compulsive hair pulling, we conducted a preliminary investigation examining the effectiveness of escitalopram, a potent and selective serotonin uptake inhibitor, in the treatment of trichotillomania. Twenty women meeting the Diagnostic and Statistical Manual-IV-Text revision criteria for trichotillomania participated in a 12-week open-label trial of treatment with escitalopram 10-30 mg/day. Response was prospectively defined as meeting the following criteria: (i) clinician version of clinical global impressions-improvement scale score of 1 or 2 (very much improved or much improved), and (ii) > or =50% reduction from baseline in the National Institute of Mental Health trichotillomania severity scale total score. Sixteen individuals, who had at least one postbaseline assessment, were included in the intention-to-treat analysis. Eight individuals (50%) were judged to be responders. Trichotillomania severity scale mean (SE) total score decreased significantly over time in the intention-to-treat analysis [15.4 (0.9)-9.4 (1.4); F=7.3; P<0.0001] and for completers [15.8 (1.0)-7.5 (1.2); F=10.1; P<0.0001]. Side effects were mild. Escitalopram treatment for 12 weeks led to significant improvement of trichotillomania in some patients in this small open-label trial.

Adolescent↗
PubMedDate not supplied

Trichotillomania: clinical aspects and treatment strategies.

Trichotillomania is a disorder of compulsive hair pulling that often results in alopecia. The clinical features include the pulling of hair from the scalp, eyebrows, and eyelashes, sometimes symmetrically; pubic and other bodily hair may also be plucked. The disorder is present in 0.6% of college students. The majority of sufferers who seek treatment are female, with usual age of onset between 11 and 16 years. Trichotillomania can occur in a wide variety of psychiatric disorders, and patients with the condition may be more likely to have a lifetime diagnosis of depression or an anxiety, eating, or substance abuse disorder. Although empirically derived treatment guidelines are still lacking, the current literature suggests that behavior therapy and pharmacotherapy are the most efficacious treatments for adult trichotillomania. Controlled trials with pharmacotherapy (clomipramine) have shown significant reductions in hair pulling over the short term. Controlled investigations of behavior therapy have not been conducted, but several treatment series suggest efficacy. At least three reports also suggest that behavior therapy and pharmacotherapy bring some improvement in childhood trichotillomania, although this has not been empirically studied. A case illustrating the combination of behavior therapy techniques and pharmacotherapy in the treatment of trichotillomania is presented.

Adolescent↗