The successful treatment of trichotillomania necessitates an initial clinical evaluation of the cognitive, emotional, behavioral, and situational characteristics contributing to an individual’s hair pulling. Assessment also requires a comprehensive psychological/psychiatric interview to assess for comorbid illness, which may either contribute to hair pulling or require separate attention. Several instruments have been designed to assist in quantifying the core symptoms of trichotillomania and can be useful for monitoring treatment progress over time. Treatment approaches include medication, hypnosis, and behavioral therapies, especially modifications of habit reversal therapy. Controlled studies are few in number and are limited to only a few behavioral treatment approaches and medication classes. Research suggests that variations of habit reversal therapy have the greatest efficacy of the interventions investigated thus far. There is additional support for treatment with clomipramine, N-acetylcysteine, and olanzapine, in contrast to multiple other drugs that have been studied or suggested as useful for trichotillomania.
