Trichotillomania: A challenge to research and practice

This review explores several aspects of trichotillomania relevant to clinic al theory and practice. It is concluded that research outlining the phenome nology and patterns of comorbidity of trichotillomania have been advanced s ignificantly in recent years. However, no current diagnostic category appro priately classifies trichotillomania. Research with nonclinical populations suggests that trichotillomania is more common than previously believed and that additional epidemiological research is warranted. Continued elaborati on of existing etiological models incorporating varying theoretical perspec tives is also encouraged. Assessment of trichotillomania could also be impr oved by the continued development of reliable and valid standardized measur es. This article reviews both pharmacological and psychological treatments for trichotillomania, with an emphasis on habit-reversal training. Though s ome interventions appear effective in the short-term, reported relapse rate s are high and future research on treatment for trichotillomania should foc us on improving long term outcomes. It is clear that despite a recent flux of research centering on trichotillomania, significant challenges for under standing and treating this psychological disorder still exist for researche rs and clinicians. Based on this review of the literature, and on our clini cal experience with trichotillomania, we propose directions for future rese arch with this underserved psychiatric group. (C) 2000 Elsevier Science Ltd .