Trichotillomania (TTM) is an impulse disorder in which patients chronically pull out hair
resulting in noticeable hair loss. TTM is reported to affect as much as 4% of the
population with the highest incidence in childhood and adolescence. The diagnostic
criteria for TTM is likely to be revised in the planned fifth edition of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders
(DSM-V) to remove the requirement that the patient has “tension” followed by “relief”
or “gratification” after hair pulling. First-line therapy is cognitive behavioral therapy,
with strongest support for the subtype habit reversal training. Among pharmacologic
therapy, clomipramine has been most effective in clinical trials. However, selective
serotonin reuptake inhibitors are most commonly prescribed despite the lack of data
supporting their efficacy. This article reviews the clinical features and treatment options
for TTM to enhance knowledge and clinical management of TTM.
Semin Cutan Med Surg 32:88-94 © 2013 Frontline Medical CommunicationsTrichotillomania (TTM) is an impulse disorder in which patients chronically pull out hair
resulting in noticeable hair loss. TTM is reported to affect as much as 4% of the
population with the highest incidence in childhood and adolescence. The diagnostic
criteria for TTM is likely to be revised in the planned fifth edition of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders
(DSM-V) to remove the requirement that the patient has “tension” followed by “relief”
or “gratification” after hair pulling. First-line therapy is cognitive behavioral therapy,
with strongest support for the subtype habit reversal training. Among pharmacologic
therapy, clomipramine has been most effective in clinical trials. However, selective
serotonin reuptake inhibitors are most commonly prescribed despite the lack of data
supporting their efficacy. This article reviews the clinical features and treatment options
for TTM to enhance knowledge and clinical management of TTM.
Semin Cutan Med Surg 32:88-94 © 2013 Frontline Medical Communications