Longitudinal follow-up of naturalistic treatment outcome in patients with trichotillomania

Background: Little is known about the longitudinal course of treatment outc ome in patients with trichotillomania. The authors conducted a second follo w-up assessment on a cohort of hair pullers previously studied. Method: Forty-four subjects completed a hair-pulling questionnaire and pape r-and-pencil measures of hair-pulling severity and impact, psychosocial fun ctioning, depression, anxiety, and self-esteem Mean time elapsed between th e first and second follow-up assessment was 2.5 years (index evaluation to first follow-up = 3.5 years). Results: Twenty-seven subjects (61.4%) had active treatment since the first follow-up. No significant changes in hair pulling, depression, anxiety, or psychosocial functioning were reported from first to second follow-up. Sel f-esteem scores significantly worsened during this period (p = .000). A tre nd toward worsening also existed for psychosocial impact scores. Comparison of scores at index evaluation with second follow-up still showed significa nt improvement over time for hair pulling (p = .001) but significant worsen ing in self-esteem (p = .000). Treatment and responder status were unrelate d to clinical functioning, with the exception of depression and psychosocia l impact. Conclusion: Although hair pullers exhibit initial improvement with treatmen t, scale scores plateau or worsen by second follow-up. Significant worsenin g in self-esteem at second follow-up may be related to the absence of furth er improvements in hair-pulling severity. Future research should focus on t he interrelationships among self-esteem, depression, and hair pulling durin g treatment for this disorder.