Trichotillomania - Rational treatment options

Trichotillomania is a psychiatric condition characterised by chronic hair 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. Trichotillomania is currently classified in DSM-IV as an impulse control disorder. However, phenomenological observations, neurobiological investigations and pharmacological responsivity have suggested similarities between hair pulling and affective states, compulsions, ties, and displacement activities involving excessive grooming. These findings indicate that the classification and theories of the aetiology of trichotillomania may need to be reconsidered. Few pharmacological treatment studies have been conducted for trichotillomania, and among those that have been published several discrepant results have been noted. Nonetheless, certain clinical guidelines can be offered. The usual recommended pharmacological approach is to initiate treatment with an antidepressant that has serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibiting properties, This should be administered for 8 to 12 weeks. Depending on the clinical context, augmentation with anxiolytics, thymoleptics, antipsychotics, topical corticosteroids and other agents may be useful. Behavioural treatment is also an important treatment approach and should be considered either as the initial intervention or in concert with medication. Although rational options for the treatment of trichotillomania can be recommended based on the currently available literature, further controlled studies of pharmacological and nonpharmacological interventions are clearly needed.