Skip to main content
Log in

Conceptual issues in trichotillomania, a prototypical impulse control disorder

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Impulse control disorders (ICDs) are characterized by irresistible urges to perform acts that result in a reduction of tension and possibly gratification, but also have negative consequences. Trichotillomania, an ICD, is characterized by a recurrent failure to resist impulses to pull out one’s hair, resulting in noticeable hair loss. Limited information is available about structural and neurochemical differences in individuals with trichotillomania. Cognitive behavioral techniques are promising treatments for trichotillomania. Pharmacologic treatments have focussed on clomipramine and venlafaxine as potentially effective for the short term control of symptoms in trichotillomania. Selective serotonin reuptake inhibitors, though promising in open trials, seem to be largely ineffective in reducing hair pulling in controlled studies. Durability of pharmacologic benefit for the symptoms of trichotillomania, both in a small trial and in clinical experience, appears to be poor.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association Press; 1994.

    Google Scholar 

  2. Jenike MA: Obsessive compulsive and related disorders: a hidden epidemic. N Engl J Med 1989, 321:539–541.

    Article  PubMed  CAS  Google Scholar 

  3. Hollander E, Benzaquen SD: Is there a distinct OCD spectrum? CNS spectrums 1996, 1:17–26.

    Google Scholar 

  4. O’Sullivan RL, Miguel EC, Coffey B, et al.: Trichotillomania, obsessive-compulsive disorder, and Tourette syndrome: comorbid relationships and risks for expression. CNS Spectrums 1998, 3:49–51.

    Google Scholar 

  5. Rauch SL, Baxter LR, Jr.: Neuroimaging in obsessive-compulsive disorder and related disorders. In Obsessive-Compulsive Disorders: Practical Management, edn 3. Edited by Jenike MA, Baer L and Minichiello WE. St. Louis: Mosby-Yearbook; 1998:289–317. An excellent review of the functional anatomy mediating OCD and related disorders like Tourette’s syndrome. It addresses theoretic issues with interesting implications for impulse control disorders.

    Google Scholar 

  6. O’Sullivan RL, Rauch SL, Breiter HC, et al.: Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry 1997, 42:39–45.

    Article  PubMed  CAS  Google Scholar 

  7. Grachev ID: MRI-based morphometric topographic parcellation of human neocortex in trichotillomania. Psychiatry Clin Neurosci 1997, 51:315–321.

    Article  PubMed  CAS  Google Scholar 

  8. Soutullo CA, McElroy SL, Goldsmith RJ: Cravings and irresistable impulses: similarities between addictions and impulse control disorders. Psychiatric Ann 1998, 28:592–600. Addresses the phenomenologic similarities of impulse comtrol disorders and addictions, suggesting overlap of cravings with urges. This is an important conceptual paper.

    Google Scholar 

  9. Kalivas PW, Cornish J, Ghasemzadeh MB: Cocaine craving and paranoia: A combination of pharmacology and learning. Psychiatric Ann 1998, 28:569–574. Explores the fundamental anatomy, chemistry and pharmacology underlying craving at a molecular level. An inkling of what the future holds!

    Google Scholar 

  10. Ninan PT, Rothbaum BO, Stipetic M, et al.: CSF 5HIAA as a predictor of treatment response in trichotillomania. Psychopharmacol Bull 1992, 28:451–455.

    PubMed  CAS  Google Scholar 

  11. Christenson GA, Mackenzie TB, Mitchell JE: Characteristics of 60 adult chronic hair pullers. Am J Psychiatry 1991, 148:365–370.

    PubMed  CAS  Google Scholar 

  12. Mansueto CS, Stemberger RMT, Thomas AM, Golomb RG: Trichotillomania: a comprehensive behavioral model. Clin Psychol Rev 1997, 17:567–577.

    Article  PubMed  CAS  Google Scholar 

  13. Rothbaum BO: The behavioral treatment of Trichotillomania. Behavioral Psychotherapy 1992, 20:85–90.

    Article  Google Scholar 

  14. Ninan PT, Rothbaum BO, Marsteller FA, et al.: A placebo controlled trial of cognitive behavior therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000, in press. The first placebo-controlled trial of pharmacology and cognitive behavior therapy (CBT) finds CBT superior to clomipramine and placebo. A replication with a larger number of subjects is indicated.

  15. Swedo SE, Leonard HL, Rapoport JL, et al.: A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). New Engl J Med 1989, 321:497–501.

    Article  PubMed  CAS  Google Scholar 

  16. Christenson GA, Mackenzie TB, Mitchell JE, et al.: A placebocontrolled double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry 1991, 148:1566–1571.

    PubMed  CAS  Google Scholar 

  17. Stein DJ, Hollander E: Low dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry 1992, 53:123–126.

    PubMed  CAS  Google Scholar 

  18. Ninan PT, Knight B, Kirk L, et al.: A controlled trial of venlafaxine in trichotillomania: interim phase 1 results. Psychopharmacol Bull 1998, 34:221–224.

    PubMed  CAS  Google Scholar 

  19. Keuthen NJ, O’Sullivan RL, Goodchild P, et al.: Retrospective review of treatment outcome for 63 patients with trichotillomania. Am J Psychiatry 1998, 155:560–561.

    PubMed  CAS  Google Scholar 

  20. Christianson GA, Hollender DJ; Trichotillomania. Washington, DC: American Psychiatric Press; 1999. The first text book that comprehensively addresses all aspects of trichotillomania written by experts in the condition. Amust read for those interested in this fascinating disorder.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ninan, P.T. Conceptual issues in trichotillomania, a prototypical impulse control disorder. Curr Psychiatry Rep 2, 72–75 (2000). https://doi.org/10.1007/s11920-000-0046-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-000-0046-y

Keywords

Navigation