Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-22T08:10:08.670Z Has data issue: false hasContentIssue false
  • English
  • Français

Behavior Therapy and Pharmacotherapy for Trichotillomania: Choice of Treatment, Patient Acceptance, and Long-Term Outcome

Published online by Cambridge University Press:  07 November 2014

Nancy J. Keuthen ,
Richard L. O’Sullivan ,
Paige Goodchild ,
Dayami Rodriguez ,
Michael A. Jenike  and
Lee Baer
Get access Rights & Permissions [Opens in a new window]

Abstract

Sixty-three trichotillomania (TTM) patients treated in a specialty clinic were retrospectively studied for treatment referral patterns, comparison of treatment outcomes, and long-term follow-up. Patients subjectively rated their individual treatments based on success, logicality, confidence in recommending the treatment to others, outcome expectations, and compliance. Subjects referred for combined behavior therapy (BT) and medication treatment (MT) were more depressed, more anxious, and reported greater psychosocial impairment and impact secondary to hair pulling than individuals referred for either treatment alone. Neither the Massachusetts General Hospital Hair Pulling Severity Scale (HPS) nor the Rosenberg Self-Esteem Scale (SES) scores differed between those referred for combined treatment vs those receiving monotherapy. The combination therapy patients showed a greater reduction in HPS scores than those receiving single-modality treatment and no longer differed significantly from monotherapy patients following treatment in terms of Beck Depression Inventory (BDI), Beck Anxiety Index (BAI), and Sickness Impact Profile (SIP) scores. Patients treated with both BT and MT rated BT as more successful and had greater confidence in recommending the intervention. Conversely, compliance was significantly higher for MT than BT. Other treatments, especially support groups, were rated positively. Comparison of patients currently receiving treatment with those no longer in active treatment revealed no statistically significant differences. Ten of 19 patients who were out of treatment for over 1 year rated themselves as treatment responders. Significant improvements in HPS, BDI, BAI, and SES scores were reported in the few hair pullers out of treatment more than 1 year for whom objective rating scale scores were available.

Type
Feature Article
Information
CNS Spectrums , Volume 3 , Issue 9: Trichotillomania: A New Understanding , October 1998 , pp. 72 - 78
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Keuthen, NJ, O'Sullivan, RL, Sprich-Buckminster, S. Trichotillomania: current issues in conceptualization and treatment. Psychother Psychosom. 1998;67:202–213.Google Scholar
2.Keuthen, NJ, O'Sullivan, RL, Jefferys, D. Trichotillomania: clinical concepts and treatment approaches. In: Jenike, MA, Baer, L, Minichiello, WE, eds. Obsessive-Compulsive Disorders: Theory and Management. 3rd ed. Philadelphia, Pa: Mosby-Year Book; 1998.Google Scholar
3.Keuthen, NJ, Aronowitz, B, Badenoch, J, Wilhelm, S. Behavioral treatment for trichotillomania: a review. In: Stein, DJ, Christenson, GA, Hollander, E, eds. Trichotillomania: New Developments. Washington, DC: American Psychiatric Press. In press.Google Scholar
4.O'Sullivan, RL, Christenson, GA, Stein, D. Pharmacotherapy of trichotillomania: a review. In: Stein, DJ, Christenson, GA, Hollander, E, eds. Trichotillomania: New Developments. Washington, DC: American Psychiatric Press. In press.Google Scholar
5.Christenson, GA, Crow, SJ. The characterization and treatment of trichotillomania. J Clin Psychiatry. 1996;57(suppl 8):42–49.Google Scholar
6.Swedo, SE, Leonard, HL, Rapoport, JL, Lenane, MC, Goldberger, EL, Cheslow, DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med. 1989;321:497–501.Google Scholar
7.Pigott, TA, L'Heueux, FL, Grady, TA, et al. Controlled comparison of clomipramine and fluoxetine in trichotillomania. Presented at the 31st Annual Meeting of the American College of Neuropsychopharmacology; December 18, 1992; San Juan, Puerto Rico. Abstract 157.Google Scholar
8.Christenson, GA, Crow, SJ, Mackenzie, TB, Crosby, RD, Mitchell, JE. A placebo controlled double-blind study of naltrexone for trichotillomania. Presented at the 150th Annual Meeting of the American Psychiatric Association; May 26, 1994; Philadelphia, Pa. Abstract NR 597:212.Google Scholar
9.Christenson, GA, Mackenzie, TB, Mitchell, JE, Callies, AL. A placebo-controlled, double-blind, crossover of fluoxetine in trichotillomania. Am J Psychiatry. 1991;148:1566–1571.Google Scholar
10.Streichenwein, SM, Thornby, JL. A long-term, double-blind, placebo-controlled crossover trial of the efficacy of fluoxetine for trichotillomania. Am J Psychiatry. 1995:152:1192–1196.Google Scholar
11.Friman, PC, Finney, JW, Christophersen, ER. Behavioral treatment of trichotillomania: an evaluative review. Rehav Ther. 1984;15:249–265.Google Scholar
12.Peterson, AL, Campise, RL, Azrin, NH. Behavioral and pharmacological treatments for tic and habit disorders: a review. J Dev Behav Pediatr. 1994;15:430–441.CrossRefGoogle ScholarPubMed
13.Azrin, NH, Nunn, RG, Frantz, SE. Treatment of hair-pulling (trichotillomania): a comparative study of habit reversal and negative practice training. J Behav Ther Exp Psychiatry. 1980;11:13–20.Google Scholar
14.Cohen, LJ, Stein, DJ, Simeon, D, et al.Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study. J Clin Psychiatry. 1995;56:319–326.Google Scholar
15.Swedo, SE, Lenane, MC, Leonard, HL. Long-term treatment of trichotillomania (hair pulling) (letter). N Engl J Med. 1993;329:141–142.Google Scholar
16.Pollard, CA, Ibe, IO, Krojanker, DN, Kitchen, AD, Bronson, SS, Flynn, TM. Clomipramine treatment for trichotillomania: a follow-up report on four cases. J Clin Psychiatry. 1991;52:128–130.Google Scholar
17.Benarroche, CL. Discontinuation of fluoxetine in trichotillomania. Presented at the 144th Annual Meeting of the American Psychiatric Association; May 14, 1991; New Orleans, LA. Abstract NR 380:138.Google Scholar
18.lancu, I, Weizman, A, Kindler, S, Sasson, Y, Zohar, J. Serotonergic drugs in trichotillomania: treatment results in 12 patients. J Nerv Ment Dis. 1996;184:641–644.Google Scholar
19.Lerner, J, Franklin, ME, Meadows, EA, Hembree, E, Foa, EB: Effectiveness of a cognitive behavioral treatment program for trichotillomania: an uncontrolled evaluation. Behav Ther 1998;29:157–171.Google Scholar
20.Rothbaum, BO, Ninan, P. Treatment of trichotillomania: behavior therapy vs. clomipramine. Presented at the Annual Meeting of the Association for the Advancement of Behavior Therapy; November 17, 1992; Boston, Mass.Google Scholar
21.Keuthen, NJ, O'Sullivan, RL, Goodchild, P, Rodriguez, P, Jenike, MA, Baer, L. A retrospective review of treatment outcome in 63 hairpullers. Am J Psychiatry. 1998;155:560–561.CrossRefGoogle Scholar
22.Keuthen, NJ, O'Sullivan, RL, Ricciardi, JN, The Massachusetts General Hospital (MGH) Hairpulling Scale. 1. Development and factor analyses. Psychother Psychosom. 1995;64:141–145.CrossRefGoogle ScholarPubMed
23.O'Sullivan, RL, Keuthen, NJ, Hayday, CF, et al.The Massachusetts General Hospital (MGH) Hairpulling Scale. 2. Reliability and validity. Psychother Psychosom. 1995;64:146–148.Google Scholar
24.Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571.Google Scholar
25.Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: the Beck Anxiety Inventory. J Consult Clin Psychol. 1988;56:893–897.Google Scholar
26.Follick, MJ, Smith, TW, Ahern, DK. The Sickness Impact Profile: a global measure of disability in chronic low back pain. Pain. 1985;21:67–76.Google Scholar
27.Rosenberg, M, ed. Society and the Adolescent Self-image. Princeton, NJ: Princeton University Press; 1965.Google Scholar
28.Baer, L, Rauch, SL, Ballantine, T, et al.Cingulotomy for intractable obsessive-compulsive disorder. Arch Gen Psychiatry. 1995;52:384–392.Google Scholar
29.Guy, W, ed. ECDEU Assessment Manual for Psychopharmacology (revised). Washington, DC: Department of Health, Education, and Welfare. Publication No. (ADM); 1976.Google Scholar
30.Borkovec, TD, Mathews, AM. Treatment of nonphobic anxiety disorders: a comparison of nondirective, cognitive, and coping desensitization therapy. J Consult Clin Psychol. 1988;56:877–884.Google Scholar
31.Marks, IM: Review of behavioral psychotherapy. I. Obsessive-compulsive disorders. Am J Psychiatry. 1981;138:584–592.Google Scholar
32.Baer, L, Ricciardi, J, Keuthen, N, et al.Discontinuing obsessive-compulsive disorder medication with behavior therapy (letter) Am J Psychiatry. 1994;151:1842.Google Scholar