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.