Trichotillomania

Trichotillomania (hair pulling disorder), is an obsessive-compulsive spectrum disorder characterized by a long term, irresistible urge to pull out one's hair. This occurs to the degree that significant hair loss can be seen.

Epidemiology

Prevalence is 1-2% in the general population. It affects significantly more females than males. There is a high comorbidity with OCD, excoriation disorder, body dysmorphia, and tics.

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Except for clomipramine, which has shown some proven benefit in studies, SSRIs/SNRIs are generally ineffective for trichotillomania. Alternatively, antipsychotics such as those described above, may be beneficial as primary medications. Studies have also shown promising results for N-acetylcysteine and naltrexone. The main treatment for this condition is a specific type of CBT called habit reversal training.

Cognitive Behavioural Therapy (CBT) (with habit reversal) is first-line. CBT focuses specifically on: habit reversal with cognitive restructuring, awareness training, and behavioural analysis/identification of triggers, and developing competing responses.

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