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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Naltrexone for the Treatment of Trichotillomania
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A Supplemental Interview for Forms of “Affective Spectrum Disorder”
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Self-Biting Induced by Activation of L-Type Calcium Channels in Mice: Serotonergic Influences
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Trichotillomania
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“There is no accepted pharmacological intervention for trichotillomania, although there has been some suggestion that anafranil and possibly fluoxetine may be useful in the treatment of this disorder (9,10).”
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StopPulling.com: An Interactive, Self-Help Program for Trichotillomania
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“Swedo et al. (1989) demonstrated that clomipramine was superior to desipramine in reducing the symptoms of TTM, but the evidence overall for a positive impact of pharmacological treatment for TTM is weak at best.”
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Trichotillomania and co-occurring anxiety
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“NIMH Trichotillomania Severity Scale (NIMH-TSS) (Swedo et al. 1989).”
Influential
Pediatric Trichotillomania
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Treatment of Recurrent Rapunzel Syndrome and Trichotillomania: Case Report and Literature Review
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Long-Term Outcome in Pediatric Trichotillomania
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“included assessment of trichotillomania severity Massachusetts General Hospital Hairpulling Scale (MGH-HPS)[16]; Trichotillomania Scale for Children–Child and Parent versions (TSC-C/P)[17]; National Institute of Mental Health–Trichotillomania Severity Scale (NIMH-TSS)[18]; styles of hairpulling [Milwaukee Inventory fo…”
Influential
Comorbid self-injurious behaviors in 71 female hair-pullers: a survey study.
Simeon, D., Cohen, L., Stein, D., Schmeidler, J., Spadaccini, E., & Hollander, E. (1997) · Journal of Nervous and Mental Disease · doi:10.1097/00005053-199702000-00009 · Cited by 33
Identifying standardized definitions of treatment response in trichotillomania: A meta-analysis
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“It is a five-item instrument, and answers must be given in a 6-point scale, ranging from 0 (none) to 5 (most severe) (Swedo et al. 1989).”
Background
Recent Advances in the Understanding and Treatment of Trichotillomania
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“…good interrater reliability, concurrent validity, and sensitivity to hairpulling symptom changes post treatment, but more moderate internal consistency (Diefenbach, Tolin, Crocetto, Maltby, & Hannan, 2005; Rothbaum, 1992; Stanley, Breckenridge, Snyder, & Novy, 1999; Swedo et al., 1989).”
BackgroundMethodResultInfluential
Is pica in the spectrum of obsessive-compulsive disorders?
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“Many disorders within the spectrum respond to selective serotonin re-uptake inhibitors (SSRI), as does OCD [7,8].”
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Body Dysmorphic Disorder and the DSM-IV: The Demise of Dysmorphophobia
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Trauma and trichotillomania: A tenuous relationship
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Isolated eyebrow and eyelash trichotillomania mimicking alopecia areata
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Pharmacotherapy for trichotillomania
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Behavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome
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ADVANCES IN THE NEUROBIOLOGY OF OBSESSIVE-COMPULSIVE DISORDER
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Beneficial Effects of the Antiglutamatergic Agent Riluzole in a Patient Diagnosed With Trichotillomania
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Clomipramine: A Tricyclic Antidepressant Effective in Obsessive Compulsive Disorder
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An Unusual Case Report of Rapunzel Syndrome Trichobezoar in a 3-Year-Old Boy
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“[18] The patient’s long-term prognosis is excellent if behavioral therapy is used to control trichophagia, and psychological/ psychiatric follow-up is maintained.”
Trichotillomania Treatment Manual
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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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