Treatment Of Trichotillomania Research Articles

Exploring pharmacological treatment for trichotillomania: do we need better education?

Trichotillomania, also known as hair-pulling disorder, is a chronic psychiatric condition with a fluctuating course in which an individual pulls out their hair, leading to visible hair loss and psychosocial sequelae. Due to the unknown pathogenesis, the treatment of this disorder is complex and remains a challenge for dermatologists and psychiatrists. Since guidelines for treating trichotillomania are lacking and, consequently, no common treatment strategy exists, we decided to perform a large-scale, global retrospective cohort study to assess the characterized real-world prescription patterns in treating trichotillomania. The research used the TrinetX database for patients with trichotillomania (ICD 10 - F63.3) within the European and the United States Collaborative Network (EC and UC, respectively). After consulting with a psychodermatology expert, a list of 25 medications was investigated. Data on the prescription drugs of 1,275 patients from the EC and 109,741 patients from the UC were collected. In both the EC and UC cohorts, benzodiazepine derivatives, particularly lorazepam and midazolam, were the most commonly prescribed sedatives/hypnotics. Antipsychotic prescriptions, primarily haloperidol, followed benzodiazepines. After the trichotillomania diagnosis, notable changes in drug prescriptions for the EC cohort, including an increased likelihood of receiving acetylcysteine, haloperidol, quetiapine, sertraline, olanzapine, and risperidone were observed. The UC cohort showed minimal changes. Overall, both cohorts leaned toward benzodiazepine prescriptions (37% UC, 21% EC) and had limited antidepressant usage. Haloperidol (19.3%) and quetiapine (15.1%) were commonly prescribed in both cohorts. The results of our study indicate that the real-world prescription patterns for trichotillomania differ significantly from the expert-proposed therapeutic approach and point toward the necessity of creating standards of pharmacological care and better education.

Acceptance-Enhanced Behavior Therapy for Trichotillomania in Youth

Trichotillomania is a debilitating and chronic condition involving repeated hair pulling from various areas of the body. Trichotillomania often begins in childhood, suggesting that the development and understanding of treatments for trichotillomania in youth are of utmost importance, especially for successful early intervention. While habit reversal training (HRT) is considered the gold standard treatment for trichotillomania in young people, this article reviews a nascent treatment approach for trichotillomania in youth, acceptance-enhanced behavior therapy (AEBT). AEBT combines HRT and acceptance and commitment therapy skills. Each component of AEBT is described and reviewed. A detailed case exemplar of the 10-session protocol is presented. Future research directions and important clinical considerations are discussed.

Accelerated Continuous Theta Burst Stimulation in the Treatment of Trichotillomania: A Comprehensive Case Study From Acute Intervention to Maintenance Phase.

Accelerated Continuous Theta Burst Stimulation in the Treatment of Trichotillomania: A Comprehensive Case Study From Acute Intervention to Maintenance Phase.

Predicting response to and relapse after treatment of trichotillomania with the Comprehensive Behavioral model (ComB).

Prior studies of behavior therapy for trichotillomania (TTM) have shown that response is variable, and relapse after treatment discontinuation is common. Little information is available concerning prognostic factors capable of predicting individual differences in response or maintenance of improvement. The present study is a secondary analysis of a randomized controlled trial (N = 36) of the Comprehensive Behavioral (ComB) model of treatment for TTM (Carlson et al., 2021). We investigated age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and Emotion and Intention hair pulling styles as predictors of initial response. We studied age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and post-treatment symptom severity or hair-pulling abstinence as predictors of relapse following treatment. Older age significantly predicted lower TTM severity following treatment. Lower pre-treatment severity significantly predicted lower severity of TTM at the 3-month follow-up.

Advances in Psychodermatology: Pediatric Trichotillomania

Trichotillomania (TTM) is a complex disease that often presents first to pediatric dermatologists. Despite its high prevalence in childhood, limited recommendations and treatment modalities are available for pediatric TTM. While Habit Reversal Therapy and Cognitive Behavioural Therapy are the most commonly used treatments for children with trichotillomania, pediatric dermatologists are more likely to prescribe medications as a primary treatment modality. Mind-skin disorders, now referred to as psychodermatologic or psychocutaneous disorders, affect the pediatric population in both a visible and psychological manner. The rise of psychodermatology in pediatric dermatology provides the opportunity to not only address any visible skin conditions such as TTM, but also any additional psychological aspects of the disorder. This review focuses on the differences in treatment modalities for children with trichotillomania utilized by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients. Objective: Discuss the differences in treatment modalities for children with trichotillomania by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients Raise awareness of the discrepancies that exist between pediatric dermatologists and behavioural health specialists (psychologists, mental health counsellors, school counsellors) in the treatment of trichotillomania in children Facilitate further discussion between pediatric dermatologists and behavioural health specialists when treating trichotillomania in the pediatric population.

ACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report

Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.

Memantine May Reduce Hair-Pulling, Skin Picking

Memantine May Reduce Hair-Pulling, Skin Picking

The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings

Trichotillomania is characterized by recurrent pulling out of one's hair, leading to significant hair loss and accompanied by clinically significant distress and/or functional impairment. The current study used data from a randomized controlled trial comparing the effectiveness of acceptance-enhanced behavior therapy (AEBT) to psychoeducation plus supportive therapy (PST; active control) for trichotillomania in an adult sample. The objectives were to examine the moderating and mediating influence of trichotillomania-specific psychological flexibility in treatment for trichotillomania. Participants with lower baseline flexibility performed better in AEBT than PST in terms of greater symptom reduction and quality of life. Lower baseline flexibility also predicted higher likelihood of disorder recovery in AEBT relative to PST. In addition, relative to PST, symptom reduction in AEBT was mediated by psychological flexibility, controlling for anxiety and depression. These findings suggest that psychological flexibility is a relevant process of change in the treatment of trichotillomania. Clinical implications and directions for future research are discussed.

The efficacy and feasibility of a fully automated, web-based acceptance-enhanced behavioral treatment for trichotillomania in adults: A randomized waitlist-controlled trial

Treatment access for those with trichotillomania is limited by several issues including professionals’ lack of knowledge of the disorder, proximity to providers, and financial constraints. Acceptance-enhanced behavioral therapy (AEBT) has been implemented in groups and using telehealth to reach a larger population. However, these methods still require therapist time and incur notable costs. This study aimed to address the gap in trichotillomania treatment accessibility by examining the feasibility and efficacy of a self-guided, web-based AEBT treatment for adults with trichotillomania across the United States. Participants completed an eight-module asynchronous program over eight weeks. The effects of the website were tested with 81 adults with trichotillomania randomized into a treatment and waitlist condition. Results demonstrated statistically stronger decreases in the treatment condition over the waitlist condition across outcomes including trichotillomania symptoms severity, trichotillomania-related psychological flexibility, well-being, total distress, depression, and stress. Treatment effects were maintained at one month follow-up. Anxiety did not significantly decrease between conditions, but a significant decrease was found across time. Of participants in the treatment condition, 52.8% (vs 15% for waitlist) met treatment responder status from pre-to post-treatment and 30.5% (vs 10% for waitlist) met responder status from pre-treatment to follow-up. Implications of these preliminary findings are discussed.

Trichotillomania – therapeutic possibilities

Introduction: Trichotillomania is a mental disorder in which the patient persistently and recurrently pulls out his own hair, which results in varying degrees of hair loss. This causes considerable suffering and impairs quality of life, but patients rarely seek specialist help. It affects 0.5–3% of the general population, but data may be underestimated due to low reporting. Aim of the study: The aim of our study is to summarize the current state of knowledge on the treatment of trichotillomania. Materials and methods: The literature available in the PubMed and Google Scholar database was reviewed using the following keywords: "trichotillomania", "trichophagia", "trichobeozar", "trichotillomania treatment". Results: Treatment of TTM is difficult and involves many methods. The division of therapeutic methods focuses mainly on psychotherapy and pharmacological treatment. The greatest effectiveness is attributed to cognitive-behavioral therapy, especially habit reversal training. Medications can help reduce symptoms, especially in the presence of other disorders, e.g. depression, anxiety disorders. Conclusions: Trichotillomania contributes to significant suffering and negatively affects functioning in social and professional life. The basis of its treatment is psychotherapy, but there are many reports on the effectiveness of selected drugs (SSRIs, clomipramine, antipsychotics, N-acetylcysteine, naltrexone, lamotrigine, bupropion, dronabinol, inositol), but they require further research on a larger group of patients.

Moderators and processes of change in a pilot randomized controlled trial of acceptance-enhanced behavior therapy for trichotillomania in adolescents

Treatments for trichotillomania in adolescence have historically been under-researched. This paper presents secondary analyses of treatment moderators and processes of change from a pilot trial assessing the efficacy of teletherapy acceptance-enhanced behavior therapy (AEBT) in adolescents (N = 28). All participants received 10 sessions of AEBT and completed questionnaires at baseline, post-treatment, and longitudinal follow-up from three-, six-, and twelve-months. The moderation effects of baseline general psychological inflexibility, baseline trichotillomania-specific psychological inflexibility, age, and comorbid diagnoses were explored via multilevel modeling using longitudinal outcomes. Comorbid conditions significantly moderated treatment outcome, indicating that more comorbidity was associated with better outcome, even when controlling for pre-treatment trichotillomania severity. No other moderators were significant. Changes in trichotillomania-specific psychological inflexibility from session-by-session data were also examined via multilevel modeling. The results from the models indicated that there was a bidirectional relationship between trichotillomania symptom severity and distress with trichotillomania specific psychological inflexibility. However, review of the slopes from the models suggested that changes in trichotillomania-specific psychological inflexibility may contribute to subsequent improved symptom severity. This study highlights the importance of comorbidity and changes in trichotillomania-specific psychological flexibility during the treatment of youth trichotillomania.

Development of a measure of hair pulling modalities

The Comprehensive Behavioral (ComB) model of treatment for trichotillomania (TTM) organizes cues for, and perceived consequences of, hair pulling in terms of five modalities (Sensory, Cognitive, Affective, Motoric, Place - SCAMP). The model proposes that assessment based on the SCAMP domains facilitates treatment by guiding individualized conceptualization of hair pulling. Empirical testing of this idea has been limited by the absence of a standardized, validated measure of SCAMP domains. This research was intended to develop such a measure. After preliminary work on content and format of the provisional test, Study 1 (N = 277 adult hair pullers, 97% female) utilized a provisional 27-item questionnaire. Item-level analyses led to deletion of some items. Subscales were low in internal consistency, and new items were added to each. A revised version of the SCAMP measure was examined in Study 2 (N = 184 adult hair pullers, 90% female) and again subjected to item-level and subscale-level analyses. Subscales of the final 49-item SCAMP measure showed high internal consistency and 2-month retest reliability as well as logically expected relations with symptom severity and hair pulling styles. The SCAMP test should prove useful in future TTM research and therapy settings.

Comprehensive Behavioral Treatment of an Older Adult Man with Trichotillomania

The Comprehensive Behavioral (ComB) model of treatment for trichotillomania (TTM) and other body-focused repetitive behaviors offers a framework for individualized, flexible intervention based on functional analysis. This case report focuses on the treatment of a patient who enrolled in the first randomized clinical trial of ComB for TTM (Carlson et al., 2021) as well as a long-term follow-up of participants from that trial conducted during the COVID-19 pandemic (Flannery et al., in press). Walter (pseudonym) entered the treatment trial at 69, having had TTM since age 17 but not received treatment for it. Walter showed clinically significant improvement in treatment, ultimately abstaining from hair pulling for two years. A single case from a parallel-groups trial cannot support strong conclusions about why his results were favorable, but qualitative review of Walter’s experience in therapy suggested that allowing him a good deal of collaborative input on the specific methods of implementation of ComB principles was helpful. Along with the general literature on patient age as a predictor of therapy outcome, Walter’s case serves as a reminder that older adults, even those with highly chronic clinical conditions, can benefit greatly from psychotherapy.

A narrative approach to trichotillomania

IntroductionTrichotillomania is an obsessive-compulsive spectrum disorder characterized by recurrent and uncontrolled hair pulling. This behavior causes significant anxiety as well as low self-esteem in people who suffer from this disorder. There is still no therapy of proven efficacy in the treatment of trichotillomania. Psychotropic drugs and cognitive behavioral psychotherapy have been tried in the management of this disease, but the relapse rate is high. Narrative therapy is an innovative type of postmodern psychotherapy and in our literary search we have not found data related to its use in the treatment of trichotillomania.ObjectivesTo present a novel therapeutic approach to a highly resistant disorder, trichotillomania.MethodsCase report and literature review.ResultsWe present a case of a 39-year-old woman diagnosed with trichoticolomania twenty years earlier. She tried several types of psychotherapies for manage her hair-pulling problem, all related with relapse only a few days after finishing the sessions. We have carried out a total of 5 narrative therapy sessions spread over 3 months. No relapses have been observed during the subsequent 9-month follow-up period.ConclusionsBased on our experience, we believe that Narrative Therapy is a good and still unexplored alternative for people diagnosed with trichotillomania.DisclosureNo significant relationships.

Trichotillomania in adulthood, a case report

IntroductionTrichotillomania is a disorder (estimated prevalence 0.5-2.0%) with common onset in childhood, rarely seen in adulthood, characterized by the repetitive pulling out of one’s own hair leading to hair loss and functional impairment, associated with other comorbidities: major depression (39-65%), anxiety disorder (23-32%), SUDs (15-19%), OCD (13-27%).ObjectivesTo present a case of late-onset trichotillomania in a 60-year-old woman.MethodsThe present study is a case report of a patient visited in outpatient psychiatry for trichotillomania. We also searched previously case reports, series and systematic reviews of clinical trichotillomania using a pubmed query.ResultsThis is a 60-year-old morbidly obese woman diagnosed with dysthymia, binge eating disorder and histrionic personality disorder. She explained a worsening of anxiety associated with work problems of one year of evolution and, for six months, the beginning of the plucking of eyebrow hairs and scabs to decrease this symptom, with inability to avoid the behaviour and without eating the hairs. The mental evaluation highlighted psychic anxiety, hypothymia, low self-esteem and feelings of failure and did not suggest a delirium. We started treatment with topiramate up to 150mg/day which was not successful. After that we switched to fluoxetine up to 60mg/day associated to psychotherapy observing a slight gradual improvement.ConclusionsThe clinical presentation suggested the diagnosis of trichotillomania in the context of dysthymia. No particular medication demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on individual trials with small sample sizes. Research findings also recommend psychotherapy based on habit reversal.DisclosureNo significant relationships.

Psychotherapeutic Treatments of Trichotillomania

IntroductionTrichotillomania (TTM), also known as hair pulling disorder, is an obsessive- compulsive disorder characterized by the recurrent, overwhelming urge to repeatedly pull out one’s hair. Hair pulling can occur anywhere on the body but is most common on the scalp, eyebrows, and eyelashes and subsequently results in bald patches. While TTM is a very prevalent, debilitating disorder, there is still no FDA approved treatment that exists.ObjectivesThe main objective of this study is to explore the various forms of available psychotherapy available for the treatment of trichotillomania.MethodsTwo independent reviewers conducted title, abstract, full-text searching and data extraction among the PubMed, PsycINFO, and ResearchGate data bases. Of the 79 articles screened, five were included in this reviewResultsHabit reversal therapy (HRT) is a form of cognitive behavioral therapy that is considered the first line treatment for management of TTM. Other psychotherapeutic techniques include acceptance and commitment therapy, progressive muscle relaxation, and mindfulness therapy.ConclusionsThis study supports the current data which states that HRT is the first line treatment and there is yet to be a pharmacological treatment of choice for TTM. It is also very important to note that TTM is still underdiagnosed and can be mistaken for a dermatological disorder like alopecia aerata. Furthermore, many people with trichilemmoma have underlying mental health disorders such as anxiety and depression that must first be addressed before treating the hair pulling itself.DisclosureNo significant relationships.

The Potential of N-Acetylcysteine for Treatment of Trichotillomania, Excoriation Disorder, Onychophagia, and Onychotillomania: An Updated Literature Review.

Background: Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to the skin, hair, and/or nails with clinically significant psychosocial consequences. Currently, there are no standardized treatments for these compulsive, self-induced disorders. Studies on treatment of these disorders using psychotropic drugs (i.e., selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants) have shown variable efficacy. Recently, there is a growing interest in N-acetylcysteine (NAC) for treating BFRBs. NAC is a glutamate modulator that has shown promise in successfully reducing the compulsive behaviors in BFRB disorders. This article provides an updated review of the literature on the use of NAC in TTM, excoriation disorder, onychophagia, and onychotillomania. Methods: Relevant articles were searched in the PubMed/MEDLINE database. Results: Twenty-four clinical trials, retrospective cohort studies, and case reports assessing the efficacy of NAC in TTM, excoriation disorder, and onychophagia were included. No studies for onychotillomania were found in our search. Conclusions: Although NAC has proven successful for treatment of BFRB disorders, data is derived from few clinical trials and case reports assessing small numbers of patients. Larger studies with longer durations are needed to fully establish the efficacy of NAC in these disorders.

Pilot trial of a technology assisted treatment for trichotillomania

The present study examined the usability, acceptability, feasibility, and preliminary efficacy of a prototype wrist-worn motion detection device and accompanying mobile app, developed by HabitAware®, as a system for delivering self-administered Habit Reversal Training (HRT). As an exploratory aim, the effect of the device and HRT app combination was compared to a reminder bracelet. The pilot trial included 15 adults with trichotillomania who interacted with the device and app system (n = 10) or reminder bracelet (n = 5) for 4 weeks. Participants in the device and app condition reported high usability, acceptability, and perceived efficacy of the system. The device and HRT app combination reduced hair pulling severity. Individuals in the reminder bracelet condition also showed a significant improvement in hair pulling. A future efficacy study with a larger sample size, longer timeframe, and improved gesture detection algorithm is warranted.

Longitudinal outcomes from a pilot randomized controlled trial of telehealth acceptance-enhanced behavior therapy for adolescents with trichotillomania

Trichotillomania is a chronic and impairing disorder typically beginning in youth. There is growing research on the use of acceptance-enhanced behavior therapy (AEBT) for trichotillomania in youth. However, few studies explore long-term outcomes for youth who receive treatment for trichotillomania, particularly AEBT. The current study presents longitudinal data from a pilot randomized controlled trial utilizing AEBT for adolescents with trichotillomania. Twenty-eight adolescents and their caretakers completed measures at pre-treatment, post-treatment, three-, six-, and 12-month follow-up timepoints. Medium to large decreases were found over time for adolescent and parent-reported trichotillomania severity, trichotillomania-related distress, and mental health functioning. Results also indicated small and medium improvements in adolescent-reported trichotillomania-related psychological inflexibility. No significant effects were found for youth-reported general psychological inflexibility or parental psychological inflexibility. These results present preliminary and promising long-term outcomes following AEBT for trichotillomania in adolescents, adding to growing evidence that AEBT may be an appropriate treatment for youth with trichotillomania.

Extended follow-up of a comprehensive behavioral (ComB) treatment sample during the COVID-19 pandemic

This study provides the longest follow-up yet for comprehensive behavioral (ComB) treatment of trichotillomania (TTM) (M = 24.59 months after pre-treatment and 15.92 months after the last follow-up point in a recent clinical trial (Carlson et al., 2021), which had shown ComB to be significantly more efficacious than minimal attention at post-treatment). This study also examined changes in TTM severity from before to during the COVID-19 pandemic. Participants (N = 23) completed a survey assessing current TTM symptoms, the impact of the pandemic on their coping with TTM, and their experience with ComB treatment. Self-reported symptom severity at this follow-up evaluation fell between the scores obtained at the clinical trial’s pre-treatment assessment and at its last follow-up before the pandemic and did not significantly differ from either time point. Most participants (73%) reported some change in their TTM management since onset of the pandemic, with changes to their environment/routine (61%) and in anxiety (32%) being the most common. Pandemic-related changes were associated with variable outcomes, improving symptoms and management for some while worsening them for others. Use of strategies from ComB had declined since the most recent follow-up, but more than half (55%) of participants reported that strategies from ComB remained useful.