A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania.
BACKGROUND
The major treatments reported to be effective in the treatment of trichotillomania are cognitive-behavioral therapy (CBT) with habit reversal and serotonin-norepinephrine reuptake inhibitors such as clomipramine. However, the 2 treatments have not been previously compared with each other. This study examines the efficacy of CBT and clomipramine compared with placebo in the treatment of trichotillomania.


METHODS
Twenty-three patients with trichotillomania as determined by the Structured Clinical Interview for DSM-III-R entered and 16 completed a 9-week, placebo-controlled, randomized, parallel-treatment study of CBT and clomipramine. Efficacy was evaluated by the Trichotillomania Severity Scale, the Trichotillomania Impairment Scale, and the Clinical Global Impressions-Improvement scale, which were conducted by an independent assessor blinded to the treatment condition.


RESULTS
CBT had a dramatic effect in reducing symptoms of trichotillomania and was significantly more effective than clomipramine (p = .016) or placebo (p = .026). Clomipramine resulted in symptom reduction greater than that with placebo, but the difference fell short of statistical significance. Placebo response was minimal.


CONCLUSIONS
Clinicians should be aware of the potential treatments available for trichotillomania. A larger and more definitive study comparing CBT and a serotonin-norepinephrine reuptake inhibitor is indicated.
Ninan
P T
PT
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA.
Rothbaum
B O
BO
Marsteller
F A
FA
Knight
B T
BT
Eccard
M B
MB
D000328:Adult; D002997:Clomipramine / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014256:Trichotillomania / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*
D002997:Clomipramine; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors