Trichotillomania consists of repetitive, uncontrolled pulling of one's
body hair. Most commonly, scalp hair, eyelashes, and eyebrows are pulled,
although hair may be pulled from any location. In some cases, trichotillomania
is related to an increased stress level at home or school, while for other
children, it is simply a learned habit that has strengthened over time.
Treatment: The primary treatment approach for trichotillomania is
habit reversal training combined with stress management and behavioral
contracting. treatment begins with self-monitoring of hair-pulling episodes as
well as the feelings that are most likely to lead to hair pulling.
Youngsters are then systematically taught a new behavior, for example,
squeezing a ball or tightening their fist, that they are to do whenever they
feel the urge to pull. Relaxation training and other stress management
techniques are used to diminish hair-pulling urges, while reward charts help
children track their progress and earn small rewards for treatment gains.
Here are a few facts:
- 2% to 4% of the population may suffer from chronic hair pulling ....
that's 8 MILLION people in the US alone!
- The average onset of trichotillomania is 12 to 13 years old ... most are
- Many different treatments are available and treatment outcome is good
when appropriately accessed.
- A sufferer sometimes experiences a sense of increasing tension before
hair-pulling and can feel a sense of relief or release of tension afterward.
Sometimes people even express a degree of pleasure after the hair-pulling.
- In order of frequency, people pull hair from their scalp, eyelashes,
eyebrows, pubic area, beard, mustache, arm, and legs
Trichotillomania, New Trials
A Controlled Trial of Venlafaxine
The following information was published July, 2003
in the New England
Journal of Medicine, and is edited for brevity.
Beyond Panic: Medication Effects in Anxiety Disorders
A Controlled trial of Venlafaxine in Trichotillomania
Philip T. Ninan, M.D., Bettina Knight, B.S.N., Lori Kirk, B.S., Barbara O.
Rothbaum. PhD., Jeffery Kelsey, M.D., Ph.D., and Charles B. Nemeroff, Ph.D.
Abstract: This article reports on the preliminary findings of a two-phase trial
examining the efficacy of venlafaxine in trichotillomania. Phase 1 is a 12
week, open label, prospective trial of venlafaxine in trichotillomania.
Venlafaxine was effective in significantly reducing the symptoms of
trichotillomania; 8 of 12 patients were considered responders. The
implications of the efficacy of venlafaxine in trichotillomania are
discussed , including its important advantages over other available
antidepressants and anxiolytic medications.
Trichotillomania is a psychiatric illness characterized by a recurrent
failure to resist impulses to pull out one's hair resulting in noticeable
hair loss. It affects mostly females, often at prepuberty. Trichotillomania
is is prevalent in the population, about 8 million in the USA, and can cause
significant distress and social impairment. It is classified as an impulse
control disorder, though it is also considered an obsessive-impulsive
spectrum disorder and shares components of stereotypic movement and tic
A dose of venlafaxine was tirated to a target range (150-375 mg) with
efforts made to achieve 375 mg unless limited by side effects.
The average age of the participants was 38.75 years, 24-56, and the average
time patients had trichotillomania was 27 years.
This preliminary study documents the beneficial effects of venlafaxine in
the short-term symptomatic management of trichotillomania.
None of the patients who received a placebo responded.
The current study suggests that venlafaxine has therapeutic benefits in
trichotillomania probably through powerful inhibition of both serotonin and
The efficacy of clomipramine and venaflaxine, and the seeming lack of
benefits with flouxetine suggest that duel inhibition of the serotonin and
norepinephrine reuptake are necessary for prominent treatment benefits in
It is critical to examine the longer term benefits of pharmacological
management of trichotillomania, Impulse control disorders, in general, and
trichotillomania in particular, may be easily controlled in the short run.