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.


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.

Habit reversal therapy (HRT) (a form of cognitive behavioural therapy) is the first-line treatment.[1] HRT's premise is that the best way to shift a habit is to diagnose and retain the old cue and reward, and to try to change only the routine itself. Thus. HRT includes cognitive restructuring, awareness training, and behavioural analysis/identification of triggers, and developing competing responses.

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Trichotillomania Guidelines

Guideline Location Year PDF Website
American Psychiatric Association (APA) USA 2016 - Link