Review of Psychopharmacological Approaches for Trichotillomania and Other Body-Focused Behaviors

Abstract

Trichotillomania I Skin picking I Excoriation I Hair pulling I Pharmacology I Treatment Opinion statement N-acetyl cysteine (NAC) is a safe, generally well-tolerated option for these disorders, and so I usually suggest a trial of NAC. If after 3 months and no response, I consider other options. If the person has urges to pull or pick and they have first-degree relatives with addictions, then I suggest a trial of naltrexone. If they have significant anxiety or depression co-occurring with the pulling, I often suggest clomipramine as a possible treatment for both conditions. In the case of skin picking with co-occurring depression or anxiety, I recommend a selective serotonin reuptake inhibitor (SSRI). Although we only have open-label data to support its use, I often use dronabinol in individuals who pick or pull most of the time unconsciously. Finally, I might suggest an antipsychotic for some people who have failed all else. Due to the side effects of antipsychotic medications, I use these only as a last resort.

Comprehensive Behavioral Therapy of Trichotillomania: A Multiple-Baseline Single-Case Experimental Design

“…Single-case experimental designs are a valuable approach during the early stages of testing a psychological treatment's efficacy, especially when (a) the clinical features of a condition reduce the feasibility of performing RCTs and (b) the theoretical framework underlying a treatment model aims to maximize the individualization of the intervention to each patient's specific psychological functioning (Blampied, 1999;Kazdin, 2011). Since TTM is a heterogeneous disorder (e.g., Grant, 2015), sufferers vary in pulling sites, pulling styles, motivational factors underlying the behavior, and modalities, limiting the degree to which large treatment samples could be considered homogeneous. SCEDs focus on intraindividual change rather than change in the group aggregate.…”