TRICHOTILLOMANIA - RATIONAL TREATMENT OPTIONS

Trichotillomania is a psychiatric condition characterised by chronic h air pulling, which is often associated with considerable comorbidity. Typically striking during critical developmental periods in childhood or early adolescence, the disorder tends to follow a chronic course. T richotillomania is currently classified in DSM-IV as an impulse contro l disorder. However, phenomenological observations, neurobiological in vestigations and pharmacological responsivity have suggested similarit ies between hair pulling and affective states, compulsions, ties, and displacement activities involving excessive grooming. These findings i ndicate that the classification and theories of the aetiology of trich otillomania may need to be reconsidered. Few pharmacological treatment studies have been conducted for trichotillomania, and among those tha t have been published several discrepant results have been noted. None theless, certain clinical guidelines can be offered. The usual recomme nded pharmacological approach is to initiate treatment with an antidep ressant that has serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibi ting properties, This should be administered for 8 to 12 weeks. Depend ing on the clinical context, augmentation with anxiolytics, thymolepti cs, antipsychotics, topical corticosteroids and other agents may be us eful. Behavioural treatment is also an important treatment approach an d should be considered either as the initial intervention or in concer t with medication. Although rational options for the treatment of tric hotillomania can be recommended based on the currently available liter ature, further controlled studies of pharmacological and nonpharmacolo gical interventions are clearly needed.