Skip to main content

A Systematic Review of Psychological and Pharmacological Interventions for the Management of Trichotillomania in Children and Adolescents

Abstract

Objective

To critically evaluate the existing literature for psychological and pharmacological interventions for the management of trichotillomania in children and adolescents.

Method

A systematic search was conducted in PubMed, OVID Medline, PsychINFO, EMBASE, the Cochrane Central Registry of Controlled Trials and Web of Science for controlled trials from 1990–2017. Studies were included if participants were aged below 18 years with trichotillomania as their primary diagnosis.

Results

From 129 records identified, 6 studies were included in the critical appraisal. Of these, two studies assessed the efficacy of N-acetyl-cysteine and one study assessed the efficacy of methylphenidate, neither showing a difference in symptoms of trichotillomania. One study of habit reversal therapy found a reduction in symptoms of trichotillomania with p-values of <0.001 and <0.002. Of the two studies investigating the efficacy of behavioural therapy, one found a significant improvement in symptoms of trichotillomania (P < 0.01). However, the other, being a low powered study, found no difference.

Conclusion

The literature available contained limited support for psychological or pharmacological therapies. More studies are necessary, particularly in the field of habit reversal therapy and behavioural therapy as these may be potentially effective treatments for children and adolescents with trichotillomania. Moreover, the use of multicentre collaborative efforts to study treatments in this low prevalence, but often highly disabling disorder is warranted.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th Edn Text Revision. Washington, DC: American Psychiatric Association.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th Edn Arlington, VA: American Psychiatric Association.

    Book  Google Scholar 

  3. Bloch, M., Panza, K., Grant, J., Pittenger, C., & Leckman, J. (2013). N-acetylcysteine in the treatment of pediatric trichotillomania: a randomized, double-blind, placebo-controlled add-on trial. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 231–240. https://doi.org/10.1016/j.jaac.2012.12.020.

    Article  Google Scholar 

  4. Bouwer, C., & Stein, D. (1998). Trichobezoars in trichotillomania. Psychosomatic Medicine, 60(5), 658–660. https://doi.org/10.1097/00006842-199809000-00025.

    Article  PubMed  Google Scholar 

  5. Christenson, G. A., Pyle, R. L., & Mitchell, J. E. (1991). Estimated lifetime prevalence of trichotillomania in college students. Journal of Clinical Psychiatry, 52(10), 415–417. https://www.ncbi.nlm.nih.gov/pubmed/1938977.

  6. De Sousa, A. (2008). An open-label pilot study of naltrexone in childhood-onset trichotillomania. Journal of Child and Adolescent Psychopharmacology, 18(1), 30–33. https://doi.org/10.1089/cap.2006.0111.

    Article  PubMed  Google Scholar 

  7. Flessner, C., Woods, D., Franklin, M., Keuthen, N., Piacentini, J., Cashin, S., & Moore, P. (2007). The milwaukee inventory for styles of trichotillomania-child version (MIST-C). Behavior Modification, 31(6), 896–918. https://doi.org/10.1177/0145445507302521.

    Article  PubMed  Google Scholar 

  8. Flessner, C., Woods, D., Franklin, M., Keuthen, N., & Piacentini, J. (2008). Styles of pulling in youths with trichotillomania: exploring differences in symptom severity, phenomenology, and comorbid psychiatric symptoms.Behaviour Research and Therapy, 46(9), 1055–1061. https://doi.org/10.1016/j.brat.2008.06.006.

    Article  PubMed  Google Scholar 

  9. Franklin, M., Edson, A., & Freeman, J. (2010). Behavior therapy for pediatric trichotillomania: exploring the effects of age on treatment outcome. Child and Adolescent Psychiatry and Mental Health, 4(1). https://doi.org/10.1186/1753-2000-4-18.

  10. Franklin, M., Edson, A., Ledley, D., & Cahill, S. (2011). Behavior therapy for pediatric trichotillomania: a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 763–771. https://doi.org/10.1016/j.jaac.2011.05.009.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Golubchik, P., Sever, J., Weizman, A., & Zalsman, G. (2011). Methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder and comorbid trichotillomania. Clinical Neuropharmacology, 34(3), 108–110. https://doi.org/10.1097/wnf.0b013e31821f4da9.

    Article  PubMed  Google Scholar 

  12. Greist, J. H., & Jefferson, J. W. (1998). Pharmacotherapy for obsessive-compulsive disorder. British Journal of Psychiatry, 173, 64–70. https://doi.org/10.1192/S0007125000297912.

    Article  Google Scholar 

  13. Gupta, M., Gupta, A., & Haberman, H. (1987). The self-inflicted dermatoses: a critical review. General Hospital Psychiatry, 9(1), 45–52. https://doi.org/10.1016/0163-8343(87)90101-0.

    Article  PubMed  Google Scholar 

  14. Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Rockville, Md: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs.

    Google Scholar 

  15. Hanna, G. (1997). Trichotillomania and related disorders in children and adolescents. Child Psychiatry and Human Development, 27(4), 255–268. https://doi.org/10.1007/bf02353354.

    Article  PubMed  Google Scholar 

  16. Houghton, D., Capriotti, M., De Nadai, A., Compton, S., Twohig, M., & Neal-Barnett, A. (2015). Defining treatment response in trichotillomania: a signal detection analysis. Journal of Anxiety Disorders, 36, 44–51. https://doi.org/10.1016/j.janxdis.2015.09.008.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jimenez-Jimenez, F., & Garcia-Ruiz, P. (2001). Pharmacological options for the treatment of Tourette’s disorder. Drugs, 61(15), 2207–2220. https://doi.org/10.2165/00003495-200161150-00005.

    Article  PubMed  Google Scholar 

  18. Keuthen, N., O’Sullivan, R., Ricciardi, J., Shera, D., Savage, C., Borgmann, A., et al. (1995). The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. development and factor analyses. Psychotherapy and Psychosomatics, 64(3–4), 141–145. https://doi.org/10.1159/000289003.

    Article  PubMed  Google Scholar 

  19. Lanoue, J., & Arkovitz, M. (2003). Trichobezoar in a four-year-old girl. New England Journal of Medicine, 348(13), 1242–1242. https://doi.org/10.1056/nejmicm02034.

    Article  PubMed  Google Scholar 

  20. National Health and Medical Research Council. (2009). NHMRC levels of evidence and grades for recommendations for guideline developers. National Health and Medical Research Council. https://www.mja.com.au/sites/default/files/NHMRC.levels.of.evidence.2008-09.pdf

  21. Rahman, O., McGuire, J., Storch, E., & Lewin, A. (2017). Preliminary randomized controlled trial of habit reversal training for treatment of hair pulling in youth. Journal of Child and Adolescent Psychopharmacology, 27(2), 132–139. https://doi.org/10.1089/cap.2016.0085.

    Article  PubMed  Google Scholar 

  22. Schumer, M., Panza, K., Mulqueen, J., Jakubovski, E., & Bloch, M. (2015). Long-term outcomes in pediatric trichotillomania. Depression and Anxiety, 32(10), 737–743. https://doi.org/10.1002/da.22390.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/chi.0b013e318179964f.

    Article  Google Scholar 

  24. Slikboer, R., Nedeljkovic, M., Bowe, S., & Moulding, R. (2015). A systematic review and meta-analysis of behaviourally based psychological interventions and pharmacological interventions for trichotillomania. Clinical Psychologist, 21(1), 20–32. https://doi.org/10.1111/cp.12074.

    Article  Google Scholar 

  25. Stein, D., Niehaus, D., Seedat, S., & Emsley, R. (1998). Phenomenology of stereotypic movement disorder. Psychiatric Annals, 28(6), 307–312. https://doi.org/10.1007/978-0-387-45944-8_3.

    Article  Google Scholar 

  26. Stein, D., Grant, J., Franklin, M., Keuthen, N., Lochner, C., Singer, H., & Woods, D. (2010). Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-5. Depression and Anxiety, 27(6), 611–626. https://doi.org/10.1002/da.20700.

    Article  PubMed  Google Scholar 

  27. Swedo, S., & Leonard, H. (1992). Trichotillomania: an obsessive compulsive spectrum disorder? Psychiatric Clinics of North America, 15(4), 777–790. https://doi.org/10.1016/s0193-953x(18)30208-9.

    Article  PubMed  Google Scholar 

  28. Tolin, D., Diefenbach, G., Flessner, C., Franklin, M., Keuthen, N., Moore, P., et al. (2008). The trichotillomania scale for children: development and validation. Child Psychiatry and Human Development, 39(3), 331–349. https://doi.org/10.1007/s10578-007-0092-3.

    Article  PubMed  Google Scholar 

  29. Wei, C., Hoff, A., Villabo, M. A., Peterman, J., Kendall, P. C., Piacentini, J., McCracken, J., Walkup, J. T., Albano, A. M., Rynn, M., Sherrill, J., Sakolsky, D., Birmaher, B., Ginsburg, G., Keaton, C., Gosch, E., Compton, N., & March, J. (2014). Assessing anxiety in youth with the multidimensional anxiety scale for children (MASC). Journal of Clinical Child Adolescent Psychology, 43(4), 566–568. https://doi.org/10.1080/15374416.2013.814541.

    Article  PubMed  Google Scholar 

  30. Wright, H. (2003). Trichotillomania (hair pulling) in toddlers. Psychological Reports, 92(1), 228. https://doi.org/10.2466/pr0.92.1.228-230.

    Article  PubMed  Google Scholar 

Download references

Author Contributions

KAA and NAA completed the literature search and decided on which papers to include or exclude. KAA wrote to paper. NAA, RAK and SM collaborated with the writing and editing of the final manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kimberley A. Adler.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Adler, K.A., Adler, N.R., Moylan, S. et al. A Systematic Review of Psychological and Pharmacological Interventions for the Management of Trichotillomania in Children and Adolescents. J Child Fam Stud 29, 913–920 (2020). https://doi.org/10.1007/s10826-019-01678-0

Download citation

Keywords

  • Trichotillomania
  • Hair pulling
  • Systematic review
  • Treatment
  • Children
  • Adolescence