This short-term, open-label study investigates short- and long-term effects of the selective serotonin reuptake inhibitor (SSRI) fluvoxamine for the treatment of trichotillomania (TTM). Additionally, this study aimed to test the hypothesis that the presence of hair pulling compulsiveness is predictive of SSRI response. Nineteen subjects meeting the Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised, (DSM-III-R) criteria for TTM were treated with fluvoxamine at doses up to 300 mg/day. Random regression analysis of change across time for patients who completed the study (n=14) and those who dropped out (n=5) revealed statistically significant improvements in Physician Rating Scale, hair-pulling episodes, Trichotillomania Impairment Scale, and Trichotillomania Symptom Severity Scale, but not in estimated amount of hair pulled. In addition, the percentage of patients' focused or compulsive hair-pulling symptoms was predictive of treatment response. Unfortunately, all three subjects who entered long-term treatment displayed substantial movement back toward baseline by the end of 6 months. We concluded that fluvoxamine produces moderate reductions in symptoms during the short-term treatment of TTM and that the presence of focused or compulsive hair pulling may be predictive of treatment response. However, responses may be short lived when treatment is extended.

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.