Abstract
The present study reports the successful use of a multi-component treatment for reducing hair pulling (trichotillomania) and resulting alopecia in a 46-year-old woman with a profound cognitive disability. The intervention consisted of a combination of noninjurious high frequency preexisting behaviors as an alternative to hair pulling and wearing of padded hand mitts as an aversive consequence to hair pulling. Results were evaluated using a single blind rating method of monthly photographs, which indicated that the intervention was effective in significantly reducing hair pulling. Social validity of the intervention was also examined. Usefulness of the intervention, problem analysis, and the method of photographic data collection in applied settings was discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Altman, K., Grahs, C., and Friman, P. (1982). Treatment of unobserved trichotillomania by attention-reflection and punishment of an apparent covariant.J. Behav. Ther. Exp. Psychiatry 13: 337–340.
Altman, K., Haavik, S., and Cook, J. W. (1978). Punishment of self-injurious behavior in natural settings using contingent aromatic ammonia.Behav. Res. Ther. 16: 85–96.
American Psychiatric Association (1987).Diagnostic and Statistical Manual of Mental Disorders (third edition-rev.), Washington, DC: Author.
Anthony, W. Z. (1978). Brief intervention in a case of childhood trichotillomania by self-monitoring.J. Behav. Ther. Exp. Psychiatry 9: 173–175.
Azrin, N. H., Nunn, R. G., and Frantz, S. E. (1980). Treatment of hair pulling (trichotillomania): A comparative study of habit reversal and negative practice training.J. Behav. Ther. Exp. Psychiatry 11: 13–20.
Barlow, K., Strother, J., and Landreth, G. (1985). Child-centered play therapy: Nancy from baldness to curls.School Couns. 32: 347–356.
Barmann, B. C., and Vitali, D. L. (1982). Facial screening to eliminate Trichotillomania in developmentally disabled persons.Behav. Ther. 13: 735–742.
Barrett, R. P., and Shapiro, E. S. (1980). Treatment of stereotyped hair-pulling with overcorrection: A case study with long term follow-up.J. Behav. Exp. Psychiatry 11: 370–320.
Bernard, M. E., Kratochwill, T. R., and Keefauver, L. W. (1983). The effects of rational-emotive therapy and self-instructional training on chronic hair pulling.Cognitive Ther. Res. 7: 273–279.
Byrd, G. R., Sawyer, B. P., and Locke, B. J. (1983). Improving direct care via minimal changes in conventional resources: An empirical analysis.Ment. Retard. 21: 164–168.
Chauhan, S., Jain, R. K., and Dhir, G.S. (1985). Trichotillomania: A phenomenological study.Ind. J. Clin. Psychol. 12: 47–50 (fromPsychological Abstracts, 1985, 75, Abstract No. 29883).
Christensen, G. A., MacKenzie, T. B., Mitchell, J. E., and Callies, A. L. (1991). A placebo-controlled, double blind crossover study of Fluoxetine in Trichotillomania.Am. J. Psychiatry 148: 1566–1571.
Corte, H. E., Wolf, M. M., and Locke, B. J. (1971). A comparison of procedures for eliminating self-injurious behavior of retarded adolescents.J. Appl. Behav. Anal. 4: 201–213.
Dahlquist, L. M., and Kalfus, G. R. (1984). A novel approach to assessment in the treatment of childhood trichotillomania.J. Behav. Ther. Exp. Psychiatry 15: 47–50.
DeAngelis, T. (1989). Medication is found to air hair-pulling: NIMH study looks at effect of Clomipramine.APA Monit. 20: 14.
de-Luca, R. V., and Holborn, S. W. (1984). A comparison of relaxation training and competing response training to eliminate hair pulling and nail bitting.J. Behav. Ther. Exp. Psychiatry 15: 67–70.
Evans, B. A. (1976). A case of trichotillomania in a child treated in a home token program.J. Behav. Ther. Exp. Psychiatry 7: 197–198.
Favell, J. E., McGimsey, J. F., and Jones, M. L. (1978). The use of physical restraint in the treatment of self-injury and as positive reinforcement.J. Appl. Behav. Anal. 11: 225–241.
Favell, J. E., McGimsey, J. F., and Schell, R. M. (1982). Treatment of self-injury by providing alternative sensory.Anal. Intervent. Devel. Disabil. 2: 83–104.
Friman, P. C., Finney, J. W., and Christophersen, E. R. (1984). Behavioral treatment of trichotillomania: An evaluative review.Behav. Ther. 15: 249–265.
Friman, P. C., and Hove, G. (1987). Apparent covariation between child habit disorders: Effects of successful treatment for thumb sucking on untargeted chronic hair pulling.J. Appl. Behav. Anal. 20: 421–425.
Friman, P. C., and Rostain, A. (1990). Trichotillomania (hairpulling).New Engl. J. Med. 332: 471.
Friman, P. C., Rostan, A., Parrish, J. M., and Carey, W. B. (1990). Hairpulling.J. Am. Acad. Child Adol. Psychiatry 29: 489.
George, M. S., Brewerton, T. D., and Cochrane, C. (1991). Trichotillomania (hair pulling).New Engl. J. Med. 332: 470–471.
Gross, A. M., Farrar, M. J., and Liner, D. (1982). Reduction of trichotillomania in a retarded cerebral palsied child using over correction, facial screening, and differential reinforcement of other behavior.Ed. Treat. Child. 5: 133–140.
Hall, J. R., and McGill, J. C. (1986). Hypnobehavioral treatment of self-destructive behavior: Trichotillomania and bulimia in the same patient.Am. J. Clin. Hypnosis 29: 39–46.
Jenike, M. A. (1990). Trichotillomania (hair pulling).New Engl. J. Med. 332: 472.
LaVigna, G. W., and Donnellan, A. M. (1986).Alternatives to Punishment: Solving Behavior Problems with Nonaversive Strategies, Irvington Publishers, Inc., New York.
Matson, J. L., Stephens, R. M., and Smith, C. (1978). Treatment of self-injurious behavior with overcorrection.J. Ment. Def. Res. 22: 175–178.
Miltenberger, R. G., and Fuqua, R. W. (1985). A comparison of contingent versus noncontingent competing response practice in the treatment of nervous habits.J. Behav. Ther. Exp. Psychiatry 16: 195–200.
Muller, S. A. (1987). Trichotillomania.Dermatol. Clin. 5: 595–601.
O'Neill, R. E., Horner, R. H., Albin, R. W., Storey, K., and Sprague, G. R. (1990).Functional Analysis of Problem Behavior: A Practical Assessment Guide, Sycamore Publishing Company, Sycamore, IL.
Pollard, C. A., Ibe, O. I., Krojanker, D. N., Kitchen, A. D., Bronson, S. S., and Flynn, T. M. (1991). Clomipramine treatment of trichotillomania: A follow-up report on four cases.J. Clin. Psychiatry 52: 128–130.
Stevens, M. J. (1984). Behavioral treatment of trichotillomania.Psychological Rep. 55: 987–990.
Swedo, S. E., Leonard, H. L., Rapoport, J., Lenane, M. C., Goldberger, E. L., and Cheslow, D. L. (1989). A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling).New Engl. J. Med. 321: 497–501.
Swedo, S. E., and Rapoport, J. L. (1991). Annotation: trichotillomania.J. Child Psychol. Psychiatry 32: 401–409.
Tarnowski, K. J., Rosen, L. A., McGrath, M. L., and Drabman, R. S. (1987). A modified habit reversal procedure in a recalcitrant case of Trichtillomania.J. Behav. Ther. Exp. Psychiatry 18(2): 157–163.
Vatulano, L. A., King, R. A., Schahill, L., and Cohen, D. J. (1992). Behavioral treatment of children and adolescents with trichotillomania.J. Am. Acad. Child Adol. Psychiatry 31: 139–146.
Walker, G. R., McLaren, K. P., and Bonaventura, S. (1985). Changing places: A look at some realities of institutional behavior management.Ment. Retard. 23: 79–81.
Willis, J. W., LaVigna, G. W., and Donnellan, A. M. (1989).The Behavior Assessment Guide, Irvington Publishers, Inc., New York.
Wulfsohn, D., and Barling, J. (1978). From external to self-control: Behavior treatment of trichotillomania in an eleven-year-old girl.Psychological Rep. 42: 1171–1174.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Maguire, K.B., Piersel, W.C. & Hauser, B.G. The long-term treatment of trichotillomania: A case study of a woman with profound mental retardation living in an applied setting. J Dev Phys Disabil 7, 185–202 (1995). https://doi.org/10.1007/BF02585424
Issue Date:
DOI: https://doi.org/10.1007/BF02585424