Cited by 601Obsessive-Compulsive Spectrum DisordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychoanalysis and Psychopathology Research

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A Double-Blind Comparison of Clomipramine and Desipramine in the Treatment of Trichotillomania (Hair Pulling)

Swedo, Susan E., Leonard, Henrietta L., Rapoport, Judith L., Lenane, Marge C., Goldberger, Erica L., Cheslow, Deborah L.·1989·New England Journal of Medicine

DOI 10.1056/nejm198908243210803

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Abstract

Trichotillomania, an irresistible impulse to pull out one's own hair, is a chronic psychiatric illness that causes severe discomfort, interferes with daily activities, and leads to social isolation. Treatment is usually unsatisfactory. Thirteen women with severe trichotillomania completed a 10-week double-blind, crossover trial of clomipramine, a new tricyclic antidepressant agent with selective antiobsessional effects, and desipramine, a standard tricyclic antidepressant. Treatment with clomipramine resulted in significantly greater improvement in symptoms than desipramine, as indicated by physicians' ratings of the women's clinical progress on a scale in which lower scores indicate improvement (mean [+/- SD] scores: at base line, 10.0; after desipramine treatment, 8.7 +/- 2.4; after clomipramine treatment, 4.7 +/- 3.1; P = 0.006) and by scores on a trichotillomania-impairment scale, in which higher scores indicate greater impairment (at base line, 6.8 +/- 1.7; after desipramine treatment, 6.2 +/- 1.7; after clomipramine treatment, 4.2 +/- 2.7; P = 0.03). The severity of symptoms (mean base-line score, 15.9 +/- 3.8) was reduced more by clomipramine (10.6 +/- 6.4) than by desipramine (14.4 +/- 3.9). The patients reported that the compulsion decreased in intensity and that they were more able to resist the urge to pull out their hair during treatment with clomipramine. We conclude that clomipramine appears to be effective in the short-term treatment of trichotillomania.

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Evidence for Reduced Cerebellar Volumes in Trichotillomania
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Cutaneous Manifestations of Eating Disorders
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Age and Gender Correlates of Pulling in Pediatric Trichotillomania
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“The NIMH Trichotillomania Scale (Swedo et al., 1989) is a semi-structured clinical interview consisting of two clinical indices: the NIMH Trichotillomania Severity Scale (NIMH-TSS) and the NIMH Trichotillomania Impairment Scale (NIMH-TIS).”
BackgroundMethod
Translational approaches to obsessive‐compulsive disorder: from animal models to clinical treatment
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“Total scale scores improved significantly from pre- to posttreatment for the NIMH-TIS (Z 5 2.02, P 5.043, n 5 5).”
BackgroundInfluential
Trichotillomania ± trichobezoar: revisited
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“Similar to the CGI-Severity scale, the NIMH-TIS is a one-item severity rating assessing control, worry, and impairment of hair pulling on a 1–10 scale [130].”
BackgroundMethodInfluential
A comprehensive model for behavioral treatment of trichotillomania
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“In one study, fluoxetine was found to be no better than placebo in a double blind, crossover study design (Christenson, Mackenzie, Mitchell & Callies, 1991), in another small study, clomipramine was superior to desipramine in reducing pulling (Swedo et al., 1989).”
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Neuropsychological test performance in trichotillomania: A further link with obsessive-compulsive disorder
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Trichotillomania and its clinical relationship to depression and anxiety
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“NIMH Trichotillomania Severity Scale (NIMH-TSS) (Swedo et al. 1989).”
Influential

Authors: Swedo, S. E., Leonard, H. L., Rapoport, J. L., Lenane, M. C., Goldberger, E. L., & Cheslow, D. L.
Affiliations: National Institute of Mental Health (US)
ORCID: Swedo, Susan E.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1989-08-24
Volume: 321
Issue: 8
Pages: 497-501
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm198908243210803
OpenAlex: W2325821938
Cited by: 601
References: 31
Citations by year: 2026: 10 · 2025: 6 · 2024: 8 · 2023: 32 · 2022: 7 · 2021: 13 · 2020: 4 · 2019: 10 · 2018: 20 · 2017: 11 · 2016: 12 · 2015: 16 · 2014: 14 · 2013: 9 · 2012: 45
FWCI: 35.31
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
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 › Psychoanalysis and Psychopathology Research
Keywords: trichotillomania, clomipramine, desipramine, tricyclic antidepressants, compulsive hair pulling, obsessive-compulsive symptoms, treatment efficacy, women
MeSH terms: Adolescent, Adult, Clomipramine, Desipramine, Double-Blind Method, Female, Humans, Obsessive-Compulsive Disorder, Trichotillomania

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A Double-Blind Comparison of Clomipramine and Desipramine in the Treatment of Trichotillomania (Hair Pulling)

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