Treating trichotillomania: A meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors
Open accessAbstract
Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES = 1.41, p < 0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p = 0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p = 0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES = 0.41, p = 0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.
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Meta-analytic evidence supports habit reversal training as the usual first-line intervention for trichotillomania.
“Generally, habit reversal training is considered the first line treatment for trichotillomania, with meta-analytic evidence supporting its efficacy (Bate et al., 2011; McGuire et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as McGuire et al., 2014
McGuire et al. (2014) found larger effects when more therapeutic contact hours were provided and when habit reversal training included emotional components rather than being delivered alone.
“For example, McGuire et al. (2014) reported significantly larger effect sizes with more therapeutic contact hours and when habit reversal training was combined with emotional components (compared to “pure” habit reversal training).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as McGuire et al., 2014
McGuire et al. (2014) reported that age and comorbid anxiety or depressive disorders were not significantly related to treatment effect size.
“No significant associations were found between age or comorbid anxiety and depressive disorders and treatment effect size (McGuire et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as McGuire et al., 2014
In McGuire et al. (2014), therapeutic contact hours and combining habit reversal training with emotional components were correlated, confounding independent moderating effects.
“However, both variables were correlated, confounding independent moderating effects.”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as McGuire et al., 2014
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“Given that meta-analyses have consistently shown that drug treatments of TTM are less effective than behavioral treatments (Bloch et al., 2007 and McGuire et al., 2014), this might be considered a minor limitation.”
Emotion regulation in individuals with and without trichotillomania
Arabatzoudis, T., Rehm, I. C., Nedeljkovic, M., & Moulding, R. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.003 · Cited by 48 · see citing works
Tomas-Aragones, L., Consoli, S., Consoli, S.-G., Poot, F., Taube, K., Linder, M. D., Jemec, G., Szepietowski, J., de Korte, J., Lvov, A., et al. (2017) · Acta Dermato-Venereologica · doi:10.2340/00015555-2522 · Cited by 40 · see citing works
“(60) confirms the superiority of behaviour therapy to pharmacological treatments; especially for behaviour therapy trials that used mood-enhanced therapeutic techniques.”
BackgroundACT-enhanced behavior therapy in group format for Trichotillomania: An effectiveness study
Haaland, Å., Eskeland, S. O., Moen, E. M., Vogel, P. A., Haseth, S., Mellingen, K., Himle, J. A., Woods, D. W., & Hummelen, B. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.005 · Cited by 25 · see citing works
“Behavioral therapy (BT) is the intervention with strongest evidence of efficacy for adults and children suffering from TTM (Bloch et al., 2007, Franklin et al., 2011, McGuire et al., 2014, Snorrason et al., 2015).”
BackgroundMethodResultAsplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23147 · Cited by 42 · see citing works
“The results for the participants with SPD are in line with previous meta‐analyses (Schumer et al., 2016; Selles et al., 2016), whereas the effect size of the primary outcome measure for TTM is somewhat lower than in prior studies (McGuire et al., 2014; Slikboer et al., 2017).”
ResultLee, M. T., Mpavaenda, D. N., & Fineberg, N. A. (2019) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2019.00079 · Cited by 40 · see citing works
“Meta-Analyses In addition to the individual RCTs, two meta-analyses were identified by the literature search (Bloch et al., 2007; McGuire et al., 2014).”
BackgroundComprehensive Behavioral Treatment of Trichotillomania
Falkenstein, M. J., Mouton‐Odum, S., Mansueto, C. S., Golomb, R. G., & Haaga, D. A. F. (2015) · Behavior Modification · doi:10.1177/0145445515616369 · Cited by 41 · see citing works
“First, the protocol could be made longer; number of contact hours was positively associated with ES of behavioral treatments in a meta-analysis of TTM trials (McGuire et al., 2014).”
Gallinat, C., Moessner, M., Haenssle, H. A., Winkler, J. K., Backenstrass, M., & Bauer, S. (2019) · Journal of Medical Internet Research · doi:10.2196/15011 · Cited by 38 · see citing works
Johnson, J., & El-Alfy, A. (2015) · Journal of Advanced Research · doi:10.1016/j.jare.2015.05.001 · Cited by 37 · see citing works
“[53] examined the efficacy of SSRI therapy in 11 randomized controlled trials.”
BackgroundRahman, O., McGuire, J., Storch, E., & Lewin, A. (2017) · Journal of child and adolescent psychopharmacology · doi:10.1089/cap.2016.0085 · Cited by 35 · see citing works
“Currently, HRT is commonly used to treat adults with TTM, as well as tics and other habit disorders such as nail biting and skin picking (Bate et al. 2011; McGuire et al. 2014a).”
InfluentialSelf-citationTrichotillomania (hair pulling disorder)
Grant, J. (2019) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_529_18 · Cited by 35 · see citing works
“Finally, serotonin reuptake inhibitors are frequently prescribed for the treatment of trichotillomania, but meta-analyses have shown that only clomipramine appears to be effective and that the effect is relatively small.[34,38]”
Snorrason, Í., Berlin, G. S., & Lee, H. (2015) · Psychology Research and Behavior Management · doi:10.2147/prbm.s53977 · Cited by 36 · see citing works
Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders
Woods, D. W., & Houghton, D. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2015.1055860 · Cited by 32 · see citing works
“In adults with TTM, McGuire et al. (2014) found that the inclusion of mood-related components (i.e., CBT vs. behavior therapy), as well as increased number of treatment sessions significantly increased the effectiveness of behavior therapy.”
BackgroundMethodInfluentialBellia, F., Vismara, M. E. M., Annunzi, E., Cifani, C., Benatti, B., Dell’Osso, B. M., & D’Addario, C. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.10.040 · Cited by 32 · see citing works
Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder
Lamothe, H., Baleyte, J., Mallet, L., & Pélissolo, A. (2019) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2019-0471 · Cited by 31 · see citing works
Identifying standardized definitions of treatment response in trichotillomania: A meta-analysis
Farhat, L. C., Olfson, E., Li, F., Telang, S., & Bloch, M. H. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.10.009 · Cited by 32 · see citing works
“These trials support the effectiveness of behavioral interventions, specifically habit reversal and stimulus-control training (as reviewed in Bloch et al. 2007; McGuire et al. 2014).”
BackgroundFalkenstein, M. J., Rogers, K., Malloy, E., & Haaga, D. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22171 · Cited by 12 · see citing works
“41), while selective serotonin reuptake inhibitors had lower effect sizes (pooled effect size = 0.41; McGuire et al., 2014).”
BackgroundInfluentialTrauma and trichotillomania: A tenuous relationship
Houghton, D., Mathew, A., Twohig, M., Saunders, S., Franklin, M., Compton, S., Neal-Barnett, A., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.09.003 · Cited by 9 · see citing works
“Nevertheless, the effect sizes and durability of trauma-focused TTM interventions have not been tested in a methodologically adequate clinical trial, whereas TTM treatments that focus on emotion regulation have demonstrated efficacy in well designed studies (McGuire et al., 2014).”
Recent advances in the treatment of trichotillomania (hair‐pulling disorder)
Everett, G. J., Jafferany, M., & Skurya, J. (2020) · Dermatologic Therapy · doi:10.1111/dth.13818 · Cited by 14 · see citing works
Pharmacotherapy for trichotillomania
Hoffman, J., Williams, T., Rothbart, R., Ipser, J., Fineberg, N. A., Chamberlain, S. R., & Stein, D. J. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007662.pub3 · Cited by 32 · see citing works
Factor analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version
Alexander, J. R., Houghton, D., Twohig, M., Franklin, M., Saunders, S., Neal-Barnett, A., Compton, S., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.08.001 · Cited by 27 · see citing works
Morand‐Beaulieu, S., O’Connor, K. P., Richard, M., Sauvé, G., Leclerc, J. B., Blanchet, P. J., & Lavoie, M. E. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00081 · Cited by 28 · see citing works
Krooks, J., Weatherall, A., & Holland, P. (2018) · Journal of dermatological treatment (Print) · doi:10.1080/09546634.2017.1395389 · Cited by 21 · see citing works
“Multiple randomized control trials have reported that CBT has the most significant treatment effect; thus, CBT is indicated as first-line therapy (89,103,104).”
BackgroundSlikboer, R., Nedeljkovic, M., Bowe, S., & Moulding, R. (2017) · Clinical Psychologist · doi:10.1111/cp.12074 · Cited by 26 · see citing works
“This analysis has contributed to the literature by examining subgroups based on the nature of the control group rather than the treatment group, such as was done by McGuire et al. (2014).”
BackgroundMethodResultInfluentialPharmacotherapy for trichotillomania
Rothbart, R., Amos, T., Siegfried, N., Ipser, J. C., Fineberg, N., Chamberlain, S. R., & Stein, D. J. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007662.pub2 · Cited by 106 · see citing works
New treatment models for compulsive disorders
Grant, J. E., Fineberg, N. A., Ameringen, M. V., Cath, D. C., Visser, H. A. D., Carmi, L., Pallanti, S., Hollander, E., & van Balkom, A. J. L. M. (2015) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2015.11.008 · Cited by 22 · see citing works
“HRT has been found to be moderately effective in studies of trichotillomania (Rothbart et al., 2013; McGuire et al., 2014) and may also produce bene fi t in skin-picking disorder (Grant et al., 2012) and tic disorders such as Tourette ’ s syndrome (Deckersbach et al., 2014).”
N‐Acetylcysteine in the treatment of trichotillomania: remarkable results in two patients
Özcan, D., & Seçkin, D. (2016) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.13690 · Cited by 24 · see citing works
Computerized response inhibition training for children with trichotillomania
Lee, H., Espil, F. M., Bauer, C. C., Siwiec, S. G., & Woods, D. W. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.070 · Cited by 21 · see citing works
Psychological treatments for trichotillomania: Update and future directions
Rehm, I., Moulding, R., & Nedeljkovic, M. (2015) · Australasian Psychiatry · doi:10.1177/1039856215590029 · Cited by 16 · see citing works
Body-focused repetitive behaviors
Najera, D. B. (2022) · JAAPA · doi:10.1097/01.jaa.0000817812.38558.1a · Cited by 16 · see citing works
A review of N‐acetylcysteine in the treatment of grooming disorders
Braun, T. L., Patel, V., DeBord, L., & Rosen, T. (2019) · International Journal of Dermatology · doi:10.1111/ijd.14371 · Cited by 18 · see citing works
Ong, C. W., Woods, D. W., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Twohig, M. P. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104302 · Cited by 15 · see citing works
“No significant associations were found between age or comorbid anxiety and depressive disorders and treatment effect size (McGuire et al., 2014).”
InfluentialNeal-Barnett, A. M., Woods, D. W., Espil, F. M., Davis, M., Alexander, J. R., Compton, S. N., Walther, M. R., Twohig, M. P., Saunders, S. M., Cahill, S. P., et al. (2019) · Bulletin of the Menninger Clinic · doi:10.1521/bumc_2019_83_04 · Cited by 15 · see citing works
The Influence of Hair Pulling Styles in the Treatment of Trichotillomania.
McGuire, J., Myers, N., Lewin, A., Storch, E., & Rahman, O. (2020) · The Behavior Therapist · doi:10.1016/j.beth.2019.12.003 · Cited by 11 · see citing works
Self-citationPharmacotherapy for trichotillomania in adults
Baczynski, C., & Sharma, V. (2020) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2020.1761324 · Cited by 5 · see citing works
Rahman, S. M., Jafferany, M., & Barkauskaite, R. (2023) · Clinical and Experimental Dermatology · doi:10.1093/ced/llad247 · Cited by 14 · see citing works
O’Connor, K. P., Lavoie, M. E., Desaulniers, B., & Audet, J. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22501 · Cited by 14 · see citing works
“Recent meta-analyses found HRT effective for trichotillomania (d = 1.41; McGuire et al., 2014), skin picking (d= 1.”
BackgroundInfluentialReview of the diagnosis and management of pediatric psychodermatologic conditions: Part I
Mosca, M., Martin, K. L., Hadeler, E. K., Hong, J. J., Brownstone, N. D., & Koo, J. Y. M. (2021) · Pediatric Dermatology · doi:10.1111/pde.14888 · Cited by 13 · see citing works
Maas, J., Keijsers, G. P. J., Rinck, M., & Becker, E. S. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.6.453 · Cited by 12 · see citing works
Inducible nitric oxide synthase (NOS2) knockout mice as a model of trichotillomania
Casarotto, P. C., Biojone, C., Montezuma, K., Cunha, F. Q., Joca, S. R. L., Ċastrén, E., & Guimarães, F. S. (2018) · PeerJ · doi:10.7717/peerj.4635 · Cited by 13 · see citing works
The Beliefs in Trichotillomania Scale (Bi TS ): Factor analyses and preliminary validation
Rehm, I. C., Nedeljkovic, M., Moulding, R., & Thomas, A. C. (2019) · British Journal of Clinical Psychology · doi:10.1111/bjc.12219 · Cited by 11 · see citing works
Current and future treatments of alopecia areata and trichotillomania in children
Iorizzo, M., & Oranje, A. (2016) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2016.1217990 · Cited by 8 · see citing works
Measuring Treatment Response in Pediatric Trichotillomania: A Meta-Analysis of Clinical Trials
Farhat, L., Olfson, E., Levine, J. L. S., Li, F.-H., Franklin, M., Lee, H.-J., Lewin, A., McGuire, J., Rahman, O., Storch, E., et al. (2019) · Journal of child and adolescent psychopharmacology · doi:10.1089/cap.2019.0103 · Cited by 9 · see citing works
“These results are in line with those of RCTs for adult TTM, as metaanalyses suggest behavioral therapy is the first-line intervention for the management of TTM, while there is no clear first-line pharmacological treatment (Bloch et al. 2007; McGuire et al. 2014).”
ResultSelf-citationPsychopharmacology in dermatology: Five common disorders
Ha, E. L., & Magid, M. (2023) · Clinics in Dermatology · doi:10.1016/j.clindermatol.2023.03.010 · Cited by 10 · see citing works
Psychoeducation About Tic Disorders and Treatment
Wu, M. S., & Mcguire, J. F. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811980-8.00002-9 · Cited by 9 · see citing works
Self-citationSelf-help for body-focused repetitive behaviors: A randomized controlled trial
Schmotz, S., Weidinger, S., Markov, V., Penney, D., & Moritz, S. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100810 · Cited by 9 · see citing works
The genetics of trichotillomania and excoriation disorder: A systematic review
Reid, M., Lin, A., Farhat, L. C., Fernandez, T. V., & Olfson, E. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152506 · Cited by 11 · see citing works
Latent class analysis of emotions experienced during compulsive hair-pulling episodes.
Hicks, M. M., Mouton-Odum, S., Patyk, K. C., Zamora, R. J., & Nadai, A. D. D. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101882 · Cited by 9 · see citing works
“Empirically supported interventions for TTM include cognitive behavioral therapy (CBT) and pharmacotherapy (McGuire et al., 2014; Bloch et al., 2007).”
BackgroundArslan, S. C., Çiçek, A. U., Ucuz, İ., & Doğru, H. (2022) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2022.2052179 · Cited by 8 · see citing works
“, a moderate efficacy was reported for SSRIs in the treatment of TTM [33].”
BackgroundTrichotillomania and Skin-Picking Disorder: Different Kinds of OCD
Grant, J., & Chamberlain, S. (2015) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.130212 · Cited by 9 · see citing works
Pulling your hair out in geriatric psychiatry: a case report
Bartley, M. M., Lapid, M. I., & Grant, J. E. (2017) · International Psychogeriatrics · doi:10.1017/s1041610216002489 · Cited by 8 · see citing works
Psychosocial Treatment of Trichotillomania: A Review
Capel, L., Woolley, M. G., & Twohig, M. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.05.003 · Cited by 9 · see citing works
Trichotillomania Prevalence in an Arab Middle Eastern Population
Subki, A., Khatib, H., Butt, N., Jamjoom, M. A., Alharbi, R. S., Shaikhoon, B. M., Alharbi, M., Shaikhoon, S. M., Alzaben, F., Alghamdi, W., et al. (2022) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1955_20 · Cited by 8 · see citing works
“Given the psychological and physical consequences of TTM and the existence of effective treatments for this disorder,[11] clinicians need to identify this condition, particularly when treating patients with OCD.”
BackgroundResultKar, S. K., Dixit, S., Agarwal, V., & Tripathi, A. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.101987 · Cited by 7 · see citing works
DSM-5 Trichotillomania: Perception of Adults with Trichotillomania After Psychosocial Treatment
Houghton, D., McFarland, C. S., Franklin, M., Twohig, M., Compton, S., Neal-Barnett, A., Saunders, S., & Woods, D. W. (2016) · Psychiatry · doi:10.1080/00332747.2016.1144438 · Cited by 8 · see citing works
“Effective behavioral treatments for TTM exist (McGuire et al., 2014), but whether these brief interventions lead to observable improvements in appearance has yet to be determined.”
BackgroundElectroconvulsive therapy for trichotillomania in a bipolar patient
Fontenelle, L. F., dos Santos‐Ribeiro, S., Kalaf, J., & Yücel, M. (2019) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2019.83.1.97 · Cited by 7 · see citing works
Recent advances in trichotillomania: a narrative review
Christensen, R. E., Tan, I., & Jafferany, M. (2023) · Acta Dermatovenerologica Alpina, Pannonica et Adriatica · doi:10.15570/actaapa.2023.28 · Cited by 6 · see citing works
Clinical Aspects of Hair Pulling, Skin Picking, and Nail Biting
Falkenstein, M. J. (2016) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-016-0096-3 · Cited by 5 · see citing works
Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania
Barber, K. E., Woods, D. W., Ely, L. J., Saunders, S. M., Compton, S. N., Neal-Barnett, A. M., Franklin, M. E., Capriotti, M. R., Conelea, C. A., & Twohig, M. P. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115767 · Cited by 6 · see citing works
Eskeland, S. O., Moen, E. M., & Hummelen, B. (2018) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.17.0599 · Cited by 6 · see citing works
Obsessive Compulsive and Related Disorders
Goodman, W. K. (2014) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2014.06.005 · Cited by 6 · see citing works
Evaluation and Approach to Patients with Psychodermatoses
Mehta, H., & Narang, T. K. (2023) · Clinical Dermatology Review · doi:10.4103/cdr.cdr_3_22 · Cited by 5 · see citing works
Late development of OCD-like phenotypes in Dlgap1 knockout mice
Minagawa, K., Hayakawa, T., Akimoto, H., Nagashima, T., Takahashi, Y., & Asai, S. (2024) · Psychopharmacology · doi:10.1007/s00213-024-06668-9 · Cited by 6 · see citing works
“The responsiveness of trichotillomania patients to antidepressants is controversial (Johnson and El-Alfy 2016; Lochner et al. 2005 ; McGuire et al. 2014).”
Dramatic Improvement of Trichotillomania with 6 Months of Treatment With N-Acetylcysteine
Popova, L., & Mancuso, J. (2022) · Global Pediatric Health · doi:10.1177/2333794x221086576 · Cited by 4 · see citing works
Updates in Psychosomatic Medicine: 2014
Freudenreich, O., Huffman, J. C., Sharpe, M., Beach, S. R., Celano, C. M., Chwastiak, L., Cohen, M. A., Dickerman, A., Fitz-Gerald, M. J., Kontos, N. J., et al. (2015) · Psychosomatics · doi:10.1016/j.psym.2015.04.001 · Cited by 5 · see citing works
Review of Psychopharmacological Approaches for Trichotillomania and Other Body-Focused Behaviors
Grant, J. (2015) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-015-0058-1 · Cited by 3 · see citing works
Treating Trichotillomania (Hair‐Pulling Disorder) in a Child
Snorrason, Í., Walther, M. R., Elkin, T. D., & Woods, D. W. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22399 · Cited by 5 · see citing works
Lootens, C. M., & Nelson‐Gray, R. O. (2016) · Clinical Case Studies · doi:10.1177/1534650116649438 · Cited by 5 · see citing works
Selles, R. R., McBride, N. M., Dammann, J. E., Whiteside, S. P. H., Small, B. J., Phares, V., & Storch, E. A. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.039 · Cited by 5 · see citing works
Self-citationPsychocutaneous disorders in childhood and adolescence
Mohandas, P., Srinivasan, J., Ravenscroft, J., & Bewley, A. (2018) · Paediatrics and Child Health · doi:10.1016/j.paed.2018.10.004 · Cited by 4 · see citing works
Moritz, S., Weidinger, S., & Schmotz, S. (2023) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-023-09609-3 · Cited by 4 · see citing works
“Psychological treatments such as habit reversal training (HRT) show some efficacy (Flessner et al., 2008; Keuthen et al., 2012; McGuire et al., 2014; Woods et al., 2006).”
Self-Limited Kleptomania Symptoms as a Side Effect of Duloxetine
Miller, C. W. T., & Gallagher, K. E. (2016) · Case Reports in Psychiatry · doi:10.1155/2016/5472492 · Cited by 4 · see citing works
“Impulse control disorders (ICDs) have been described as a side effect of dopamine agonists, frequently used in neurodegenerative conditions affecting the nigrostriatal pathway.”
BackgroundInfluentialTrichotillomania in Children − How can a Dermatologist Deal with it?
Thakkar, S., & Desai, N. D. (2023) · Indian Journal of Paediatric Dermatology · doi:10.4103/ijpd.ijpd_104_22 · Cited by 3 · see citing works
Barber, K. E., Woods, D. W., Deckersbach, T., Bauer, C. C., Compton, S. N., Twohig, M., Ricketts, E., Robinson, J., Saunders, S. M., & Franklin, M. E. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104556 · Cited by 3 · see citing works
Ellington, E. E. (2017) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20170210-03 · Cited by 3 · see citing works
Trichotillomania: Case report of pharmacological treatment outcome with clomipramine
Mariusso, L. M., Costa, A. C. B., Canassa, T. C., Tanouye, A. T. D. A., & Porcu, M. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112663 · Cited by 3 · see citing works
StopPulling.com: Real-World Effectiveness of a Self-Guided Online Intervention for Trichotillomania
Barber, K. E., Woolley, M. G., Rogers, K., Hadlock, S., Woods, D. W., & Mouton-Odum, S. (2025) · Cognitive Therapy and Research · doi:10.1007/s10608-025-10584-3 · Cited by 3 · see citing works
Impulskontrollstörungen, Verhaltenssüchte und körperbezogene Zwangserkrankungen
Turner, D., & Tüscher, O. (2022) · PSYCH up2date · doi:10.1055/a-1143-0096 · Cited by 3 · see citing works
Targeting the function of inner experiences in obsessive compulsive and related disorders
Twohig, M. P., & Smith, B. M. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2014.12.033 · Cited by 3 · see citing works
Habit Reversal to Decrease Filled Pauses in Public Speaking: A Partial Replication
Bördlein, C., & Sander, A. (2019) · Research on Social Work Practice · doi:10.1177/1049731519894663 · Cited by 3 · see citing works
“Its efficacy in treating nail biting, trichotillomania, stuttering and similar problems is well documented (Bate, Malouff, Thorsteinsson, & Bhullar, 2011; Bloch et al., 2007; Dufrene, Watson, & Kazmerski, 2008; McGuire et al., 2014; Miltenberger, Fuqua, & Woods, 1998).”
BackgroundMartins, G. G., Doche, I., Freitag, L. A., Miteva, M. I., & Damasco, P. (2023) · Springer eBooks · doi:10.1007/978-3-031-13505-7_73 · Cited by 2 · see citing works
Usmani, A., Szkutak, A., & Keuthen, N. J. (2023) · Current clinical psychiatry · doi:10.1007/978-3-031-29368-9_12 · Cited by 2 · see citing works
Bhat, R. R., Vellekkat, F., Goutama, I. L., Gill, P. S., Kakar, G., Jabeen, H., Gireesh, K., Sanker, V., & Gupta, U. (2023) · Clinical Case Reports · doi:10.1002/ccr3.7800 · Cited by 2 · see citing works
Tüscher, O., & Lieb, K. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_78 · Cited by 2 · see citing works
Mouton-Odum, S., & Houghton, D. (2018) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2018.82.4.288 · Cited by 1 · see citing works
Psychopharmacotherapy of Obsessive-Compulsive and Related Disorders
Hoffman, J., & Stein, D. J. (2022) · Springer eBooks · doi:10.1007/978-3-030-62059-2_433 · Cited by 2 · see citing works
Review of Psychotherapeutic Approaches for OCD and Related Disorders
Mathes, B. M., Kirk, N. P. V., & Elias, J. A. (2015) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-015-0052-7 · Cited by 2 · see citing works
- Authors
- McGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., & Storch, E. A.
- Affiliations
- University of South Florida (US)
- Johns Hopkins University (US)
- Corresponding author
- McGuire, Joseph F.
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 58
- Pages
- 76-83
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC4163503
- OpenAlex
- W2160932918
- Cited by
- 142
- References
- 63
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 11 · 2023: 18 · 2022: 7 · 2021: 8 · 2020: 7 · 2019: 14 · 2018: 14 · 2017: 18 · 2016: 17 · 2015: 17 · 2014: 1 · 2013: 1
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH093381, R01MH093381)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- trichotillomania, hair pulling, behavior therapy, serotonin reuptake inhibitors, clomipramine, selective serotonin reuptake inhibitors, treatment moderators, treatment effect size, youth
- MeSH terms
- Adolescent, Adult, Analysis of Variance, Behavior Therapy, Clomipramine, Female, Humans, Male, Trichotillomania, Reproducibility of Results, Randomized Controlled Trials as Topic, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Young Adult
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