Treating Trichotillomania

Behavioural therapy 'effective for trichotillomania'

A Dutch study has found that behavioural therapy can be highly effective in reducing the symptoms of trichotillomania - an obsessive-compulsive disorder characterised by the irresistible urge to pull one's hair.

The findings were based on a 12-week study that compared the efficacy of behavioural therapy and the antidepressant fluoxetine in treating the condition.

Forty three people suffering from trichotillomania were included in the study. The researchers, from the University of Nijmegen, assigned them to one of three groups. The first attended six sessions of behavioural therapy, the second were given 60mg of fluoxetine a day, and the third spent 12 weeks on a waiting list with no treatment.

As part of the behavioural therapy treatment, the patients were asked to write down how many hairs they had pulled and the total amount of time they had spent hair pulling during every hour of therapy. They were also told to put on gloves in high-risk situations. The therapy was designed to improve self-control, teaching patients to control unwanted behaviour in their own environment.

Using the Massachusetts General Hospital Hairpulling Scale as a reference, the team found that patients who received behavioural therapy showed a greater reduction in symptoms of trichotillomania than patients in the fluoxetine and waiting-list groups.

'When the hair loss was rated by others using videotapes, patients who had undergone behavioural therapy were found to have improved significantly,' the researchers said.

Interestingly, patients who were in the 'waiting-list' group, and who received no treatment, also showed a significant reduction in hair-pulling symptoms. The researchers believe that this finding could be due to 'expectancy effects', as the patients had been promised treatment after 12 weeks.

In contrast, fluoxetine was found to be ineffective in reducing the symptoms of trichotillomania.

'The challenge for the future is to further refine this treatment to obtain long-term improvement,' they conclude.