August 10, 2006

Two-pronged approach best for hair-pulling disorder

By Anne Harding

NEW YORK (Reuters Health) - A new study suggests that
behavioral therapy plus medication is the most effective
approach to treating trichotillomania, a psychiatric disorder
characterized by obsessive hair pulling.

"The ultimate take-home message is that the combination is
better than either one alone," Dr. Darin D. Dougherty of
Massachusetts General Hospital in Boston, the study's lead
author, told Reuters Health.

Trichotillomania is related to obsessive-compulsive
disorder (OCD), and if left untreated generally does not
improve on its own, Dougherty noted in an interview. The
disorder can interfere with a person's personal relationships,
and lead people to avoid social and public activities.

A special type of cognitive behavioral therapy known as
habit reversal training (HRT) has been shown to be effective
for treating the disorder, as have drugs used for treating
depression and OCD known as selective serotonin reuptake
inhibitors (SSRIs). At his center, Dougherty said, doctors
generally use both treatments in patients with

To investigate whether the combination might be more
effective than either treatment alone, the researchers randomly
assigned a group of trichotillomania patients to the SSRI
Zoloft (also called sertraline) or a placebo. Those who did not
show improvement after 12 weeks were given HRT along with the
drug for an additional 10 weeks.

Of the 24 patients who completed the study, 13 received
Zoloft or HRT only and 11 received both.

While improvements were seen in both groups, they were
significantly greater among the patients given Zoloft plus HRT.

In the study, published in the Journal of Clinical
Psychiatry, the researchers failed to see significant effects
of treatment on patients' quality of life or function, but
this, they say, is likely because of the small size of the

"The trend is certainly toward improvement in function and
quality of life," Dougherty said.

Further study is needed, he and his colleagues conclude, to
determine if the benefits of combination treatment for
trichotillomania extend over the long term, and to understand
the mechanism by which the combination exerts its effects.

SOURCE: Journal of Clinical Psychiatry, July 2006.