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A Double-Blind Comparison of Clomipramine and Desipramine in the Treatment of Trichotillomania (Hair Pulling)
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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“This scale has reported sensitivity to changes in symptom severity, adequate to excellent interrater reliability, and good concurrent validity with self-reported measures of TTM severity.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Swedo et al., 1989
In the citing paper
“Psychometric data are limited, though inter-rater reliability scores have ranged from adequate to excellent, good concurrent validity has been reported, and scale scores are sensitive to changes in symptom severity with treatment.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Swedo et al., 1989
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BackgroundInfluentialThe genetic factors influencing the development of trichotillomania
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“NIMH-TSS = the National Institute of Mental Health Trichotillomania Questionnaire Severity Scale; NIMH-TIS = the National Institute of Mental Health Trichotillomania Questionnaire Impairment Scale; TSC-Parent = the Trichotillomania Scale for Children - Parent Version; TSC-Child = the Trichotillomania Scale for Childre…”
MethodClomipramine and a case of exhibitionism
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Final Exit as a manual for suicide in depressed patients
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The Black Book of Psychotropic Dosing and Monitoring
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Identification of cues associated with compulsive, bulimic, and hair-pulling symptoms
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“Studies have shown clomipramine to be effective (Christenson et al. 1992; Swedo et al. 1989; Ninan et al. 2000).”
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Paradoxical Effects of Serotonin and Opioids in Pemoline-Induced Self-Injurious Behavior
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Bupropion for SSRI-Induced Fatigue
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Trichotillomania (Hair Pulling)
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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 18
“NIMH Trichotillomania Symptom Severity Scale (Swedo et al., 1989).”
Grant, J., Valle, S., Chesivoir, E. K., & Ehsan, D. (2021) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000382 · Cited by 15
“Efficacy evaluation The primary outcome was the National Institute of Mental Health (NIMH) Symptom Severity Scale (Swedo et al., 1989) (NIMH-BFRB for trichotillomania or skin picking disorder) total score change from baseline to week 10.”
MethodReversal of trichotillomania with aripiprazole
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Obsessive-compulsive disorders and dermatologic disease.
Vythilingum, B., & Stein, D. J. (2005) · Dermatologia clinica · doi:10.1016/j.det.2005.05.006 · Cited by 17
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Treatment of pathological jealousy by fluoxetine
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Validating indicators of treatment response: application to trichotillomania
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“Antidepressants and antipsychotics are commonly used drugs for TTM, having the evidence for efficacy [2,3,6,18,25,26].”
BackgroundBadenoch, J., Searle, T., Watson, I., & Cavanna, A. E. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.10.008 · Cited by 20
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“There have been three trials involving TCAs, one of which provides limited evidence for a treatment effect of the SRI clomipramine when compared to desipramine on two out of the three outcome measures [17].”
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“As an additional control, hamsters were also treated with desipramine, a noradrenergic re-uptake inhibitor [24] that has been found ineffective in inhibiting OCD in preclinical [25] and clinical studies [26,27].”
MethodPsychotropic and neurotropic agents in dermatology: unapproved uses, dosages, or indications
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PSYCHOPHARMACOLOGY FOR DERMATOLOGIC PATIENTS
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Reversible Dyskinesia During Bupropion Therapy
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Pharmacological strategies for trichotillomania
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“2 Tricyclic antidepressants Clomipramine (CMI), a serotonergic tricyclic antidepressant (TCA), was the first medication to demonstrate efficacy for OCD, and then for TTM [31,34].”
BackgroundMethodInfluentialPsychotropic Agents in Dermatology
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Trichotillomania: Women's reports of treatment efficacy
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Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling
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“reported that clomipramine appears to be effective in the short-term treatment of trichotillomania (27).”
BackgroundNeal-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
The Influence of Hair Pulling Styles in the Treatment of Trichotillomania.
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Pharmacotherapy for trichotillomania in adults
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Hypnotherapy in Adolescents with Trichotillomania: Three Cases
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“Trichotillomania is not rare in adolescence with a reported lifetime prevalence of 1% (King et aI., 1995a; Swedo et al., 1989), in developed countries, and 0.5% in Israel (King et aI., 1995b).”
BackgroundInfluentialPrototype awareness enhancing and monitoring device for trichotillomania
Himle, J. A., Perlman, D. M., & Lokers, L. M. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.06.013 · Cited by 18
“Data on the psychometric qualities of this clinician-guided measure are limited (Stanley et al., 1999) yet interrater reliability ranged from 0.78 to 0.81 in a single study (Swedo et al., 1989).”
BackgroundMethodInfluentialComprehensive Management of Trichotillomania in a Young Autistic Girl
Holttum, J. R., Lubetsky, M. J., & EASTMAN, L. E. (1994) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199405000-00016 · Cited by 15
Trichotillomania (Hair Pulling)
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Habit reversal training for trichotillomania
Gupta, S., & Gargi, P. (2012) · International Journal of Trichology · doi:10.4103/0974-7753.96089 · Cited by 14
“Studies on the pharmacotherapy of trichotillomania remain inconsistent, [3-5] with no individual drug or group of drugs found to be clinically effective constantly.”
Behavioral and Pharmacological Treatment of Trichotillomania
Stemberger, R., Stein, D. J., & Mansueto, C. (2003) · Brief Treatment and Crisis Intervention · doi:10.1093/brief-treatment/mhg025 · Cited by 19
“In that study, clomipramine was found to be significantly more effective than desipramine for patients with hair pulling (Swedo et al., 1989), which not only offered a new treatment possibility for patients with this disorder, but it also provided some evidence for the hypothesis that trichotillomania lies on a spectr…”
BackgroundTrichotillomania: ophthalmic presentation.
Bs, J. R. S. M. (1995) · Australian and New Zealand journal of ophthamology (Print) · doi:10.1111/j.1442-9071.1995.tb01647.x · Cited by 15
Hypnotherapy: an effective treatment modality for trichotillomania
Cohen, H., Barzilai, A., & Lahat, E. (1999) · Acta Paediatrica · doi:10.1111/j.1651-2227.1999.tb01131.x · Cited by 14
Psychometric Properties of Trichotillomania Severity Measures
Barber, K. E., Woods, D. W., Bauer, C. C., Twohig, M. P., Saunders, S. M., Compton, S. N., & Franklin, M. E. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10406-4 · Cited by 14
“However, other studies have questioned this, finding that the MGH-HS was not significantly correlated with the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS; Swedo et al., 1989), the CGI-S, or a rating of hair loss severity (Diefen-bach et al., 2005a).”
Park, J. M., Rahman, O., Murphy, T., & Storch, E. (2012) · Infant Mental Health Journal · doi:10.1002/imhj.21317 · Cited by 13
“…clomipramine and selective serotonin reuptake inhibitors (SSRIs) with adults have provided mixed results (Ninan, Rothbaum, Marsteller, Knight, & Eccard, 2000; Swedo et al., 1989); a recent meta-analysis has found an effect size for SSRIs of .02 and clomipramine of −.68 (Bloch et al., 2007).”
Palmer, C. J., Yates, W. R., & Trotter, L. (1999) · Psychosomatics · doi:10.1016/s0033-3182(99)71195-3 · Cited by 13
Tratamiento con psicofármacos de los trastornos psicodermatológicos
Escalas, J., Guerra, A., & Rodríguez-Cerdeira, M. C. (2010) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2009.12.027 · Cited by 13
Tricholithobezoar Causing Gastric Perforation
Valenciano, J. S., Nonose, R., CRUZ, R. B., Sato, D. T., Fernandes, F. C. M., Nascimento, E. F., & Martinez, C. A. R. (2012) · Case Reports in Gastroenterology · doi:10.1159/000336203 · Cited by 13
Efficacy of olanzapine in the treatment of psychogenic excoriation
Blanch, J., Grimalt, F., Massana, G., & Navarro, V. (2004) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2004.06151.x · Cited by 13
Challenges in the Classification and Treatment of Trichotillomania
Ninan, P., Mansueto, C., Rothbaum, B., O'Sullivan, R. L., & Nemeroff, C. (1998) · CNS Spectrums · doi:10.1017/s1092852900006465 · Cited by 13
Leonard, H. L., Swedo, S. E., Allen, A. J., & Rapoport, J. L. (1994) · Issues in clinical child psychology · doi:10.1007/978-1-4899-1498-9_11 · Cited by 13
Treating Trichotillomania in a Toddler: Variations on Effective Treatments
Watson, T. S., Dittmer, K. I., & Ray, K. P. (2000) · Child & Family Behavior Therapy · doi:10.1300/j019v22n04_03 · Cited by 13
Treatment of a Compulsive Paraphiliac With Buspirone
Pearson, H. J., Marshall, W. L., Barbaree, H. E., & Southmayd, S. E. (1992) · Sexual Abuse · doi:10.1007/bf00849924 · Cited by 13
Pilot trial of a technology assisted treatment for trichotillomania
Stiede, J. T., Woods, D. W., Idnani, A., Pritchard, J., Klobe, K., & Kumar, S. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100726 · Cited by 11
Turk, T., Liu, C., Fujiwara, E., Straube, S., Hagtvedt, R., Dennett, L., Abba‐Aji, A., & Dytoc, M. T. (2023) · Journal of Cutaneous Medicine and Surgery · doi:10.1177/12034754231155888 · Cited by 13
PHARMACOLOGY OF PSYCHOTROPIC DRUGS USEFUL IN DERMATOLOGIC PRACTICE
Koblenzer, C. S. (1993) · International Journal of Dermatology · doi:10.1111/j.1365-4362.1993.tb02786.x · Cited by 12
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 14
14 – Cognitive-Behavioral Treatment of Impulse Control Disorders
Opdyke, D., & Rothbaum, B. (1998) · Elsevier eBooks · doi:10.1016/b978-008043433-9/50016-x · Cited by 3
Metadata
- 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
- 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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