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.

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