Therapy beats drug for hair-pulling disorder

NEW YORK, Mar 10 (Reuters Health) -- Trichotillomania -- compulsively
pulling out one's own hair -- is a difficult disorder to treat. A recent
study comparing the only two effective treatments -- a drug, and behavioral
therapy -- found that behavioral therapy gets the best results.

The disorder is more common in women. It usually begins before puberty, and
often causes a great deal of stress.

Researchers at Emory University School of Medicine in Atlanta, Georgia, led
by Dr. Philip T. Ninan, compared cognitive-behavioral therapy, the
anti-depressant drug clomipramine, and placebo (inactive) pills in 16
patients who had been pulling out their hair for an average of 20 years. The
patients, 13 of whom were female, had an average age of 33.

During the 9-week study, patients who received clomipramine or placebo also
met weekly with a psychiatrist, while those receiving behavioral therapy had
weekly sessions with a behavioral psychologist. Behavioral therapy included
awareness training, practicing alternative responses, and stress management
techniques.

Behavioral therapy ``had a dramatic effect'' in these patients, the authors
write. It proved to be significantly more effective than either clomipramine
or placebo. All five of the patients in this group showed significant
improvement, and four had completely stopped pulling out their hair by the
end of the study. Among the six patients taking clomipramine, four showed
significant improvement, but none were symptom free. The placebo group
showed no significant improvement at all.

However, patients taking clomipramine reported more side effects than most
patients taking this drug, the researchers note, including tremor,
drowsiness, and dry mouth. Four of the 10 patients that started the study in
this group dropped out. Ninan and colleagues suggest that other
anti-depressant drugs should be tried with trichotillomania patients.

Writing in the January issue of the Journal of Clinical Pharmacology, the
authors add that larger studies comparing behavioral therapy to drug
treatment should be done, as well as research on how to maintain the
improvement achieved with short-term therapy. SOURCE: Journal of Clinical
Psychiatry 2000;61:47-50.

Drs. Chow, Lauretti & Goldberg provide behavior therapy for individuals with Trichotilomania