Treatment of trichotillomania with behavioral therapy or fluoxetine: a randomized, waiting-list controlled study.
BACKGROUND
Both behavioral therapy (BT) and serotonin reuptake inhibitors have been reported effective in the treatment of trichotillomania. This study examines the efficacy of BT and fluoxetine hydrochloride compared with a waiting-list (WL) control group.


METHODS
Forty-three patients with trichotillomania entered a 12-week randomized, WL-controlled study of BT and fluoxetine (60 mg/d). Forty patients (14 in the BT group, 11 in the fluoxetine group, and 15 in the WL group) completed the trial. Treatment effects were evaluated using the Massachusetts General Hospital Hairpulling Scale, and severity of hair loss was rated by independent assessors. In addition, we measured general symptoms of psychopathologic abnormalities and depression.


RESULTS
For reducing the symptoms of trichotillomania, BT was superior. Patients in the BT group showed a significantly greater reduction in trichotillomania symptoms, higher effect sizes (Massachusetts General Hospital Hairpulling Scale: BT, 3.80; fluoxetine, 0.42; and WL, 1.09), and more clinically significant changes (BT, 64%; fluoxetine, 9%; and WL, 20%) than patients in the fluoxetine and WL groups. For severity of hair loss, a similar trend was also found in favor of the BT group. No significant differences between groups were established for general psychopathologic and depressive symptoms.


CONCLUSIONS
Behavioral therapy is highly effective for reducing symptoms of trichotillomania in the short term, whereas fluoxetine is not.
van Minnen
Agnes
A
Department of Clinical Psychology, University of Nijmegen, the Netherlands. a.vanminnen@psych.kun.nl
Hoogduin
Kees A L
KA
Keijsers
Ger P J
GP
Hellenbrand
Inge
I
Hendriks
Gert-Jan
GJ
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D012107:Research Design; 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*; D014850:Waiting Lists
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors