Two-pronged approach best for hair-pulling disorder

A new study suggests that behavioral therapy plus medication is the most effective approach to treating trichotillomania, a psychiatric disorder characterized by obsessive hair pulling.

"The ultimate take-home message is that the combination is better than either one alone," Dr. Darin D. Dougherty of Massachusetts General Hospital in Boston, the study's lead author, told Reuters Health.

Trichotillomania is related to obsessive-compulsive disorder (OCD), and if left untreated generally does not improve on its own, Dougherty noted in an interview. The disorder can interfere with a person's personal relationships, and lead people to avoid social and public activities.

A special type of cognitive behavioral therapy known as habit reversal training (HRT) has been shown to be effective for treating the disorder, as have drugs used for treating depression and OCD known as selective serotonin reuptake inhibitors (SSRIs). At his center, Dougherty said, doctors generally use both treatments in patients with trichotillomania.

To investigate whether the combination might be more effective than either treatment alone, the researchers randomly assigned a group of trichotillomania patients to the SSRI Zoloft (also called sertraline) or a placebo. Those who did not show improvement after 12 weeks were given HRT along with the drug for an additional 10 weeks.

Of the 24 patients who completed the study, 13 received Zoloft or HRT only and 11 received both.

While improvements were seen in both groups, they were significantly greater among the patients given Zoloft plus HRT.

In the study, published in the Journal of Clinical Psychiatry, the researchers failed to see significant effects of treatment on patients' quality of life or function, but this, they say, is likely because of the small size of the study.

"The trend is certainly toward improvement in function and quality of life," Dougherty said.

Further study is needed, he and his colleagues conclude, to determine if the benefits of combination treatment for trichotillomania extend over the long term, and to understand the mechanism by which the combination exerts its effects.

SOURCE: Journal of Clinical Psychiatry, July 2006.