TRICHOTILLOMANIA - CLINICAL ASPECTS AND TREATMENT STRATEGIES

Trichotillomania is a disorder of compulsive hair pulling that often r esults in alopecia. The clinical features include the pulling of hair from the scalp, eyebrows, and eyelashes, sometimes symmetrically; pubi c and other bodily hair may also be plucked. The disorder is present i n 0.6% of college students. The majority of sufferers who seek treatme nt are female, with usual age of onset between 11 and 16 years. Tricho tillomania can occur in a wide variety of psychiatric disorders, and p atients with the condition may be more likely to have a lifetime diagn osis 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 pharmacother apy are the most efficacious treatments for adult trichotillomania. Co ntrolled trials with pharmocotherapy (clomipramine) have shown signifi cant reductions in hair pulling over the short term. Controlled invest igations of behavior therapy hove not been conducted, but several trea tment series suggest efficacy. At least three reports also suggest tha t behavior therapy and pharmacotherapy bring some improvement in child hood trichotillomania, although this has not been empirically studied. A case illustrating the combination of behavior therapy techniques an d pharmacotherapy in the treatment of trichotillomania is presented.