Nonpharmacological treatment approach in trichotillomania (hair-pulling disorder)
Open accessAbstract
Trichotillomania (TTM) is a fairly common psychodermatological disorder. This is characterized by recurrent urges to pull hair from hair-containing parts of the body and produces bald patches on scalp. Besides scalp, eye lashes, eyebrows, and pubic area may be involved. Clinically two types are recognized, the automatic and focused types. Currently, this is classified into obsessive- and compulsive-related disorder. Most common psychiatric manifestations include anxiety, depression, and low self-esteem. It has bimodal distribution in children and adolescents and adults. No recognized treatment is available. Pharmacological treatment is based on limited trials and case reports. Psychotherapies are mainstay of treatment. This review mainly focuses on evidence-based psychotherapeutic techniques used in the treatment of TTM. © 2020 Wiley Periodicals LLC.
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0 of 2 cited sources checked · 0 supported · 0 flagged
- Premisecitation
Habit reversal therapy, especially when combined with pharmacological treatment, has been used successfully in case reports and trials for trichotillomania.
“Although no FDA-approved medication for TTM currently exists, habit reversal therapy (HRT) in combination with pharmacological treatment has been used successfully in different case reports and trials.”
- Also stated in: § 6.1 | Habit reversal therapy · boosted
“HRT has been widely used with success, particularly when combined with pharmacological treatment.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] 24. Jafferany M, Patel A. Therapeutic aspects of trichotillomania: a review of current treatment options. Prim Care Companion CNS Disord. 2018; 20(6):18nr02344. https://doi.org/10.4088/PCC.18nr02344. source
- Also stated in: § 6.1 | Habit reversal therapy · boosted
- Interpretationreasoning
Habit reversal therapy remains a promising treatment for many patients with trichotillomania.
“However, for many patients, HRT remains promising and increased awareness of TTM and HRT as a treatment method should be stressed at a primary care and dermatologic level to determine its effectiveness more accurately.”
Quote in the paperSubstantial claim - Interpretationreasoning
Psychotherapeutic modalities, particularly habit reversal therapy, are the mainstay or treatment of choice for trichotillomania.
“Psychotherapies are mainstay of treatment.”
- Also stated in: § 7 | CONCLUSION · plain
“Serotonergic, dopaminergic, and glutamatergic agents may show some promise; however, psychotherapeutic modalities, particularly habit reversal therapy, are still the treatment of choice.”
Quote in the paperSubstantial claim- Rests on an assumption: No specific pharmacological agent has been approved for the treatment of trichotillomania.
- Rests on an assumption: Pharmacological treatment for trichotillomania is based on limited trials and case reports.
- Also stated in: § 7 | CONCLUSION · plain
- Classified as probably not a substantial claim. 1
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationUnderlying feelings play a major role in many psychiatric conditions, including trichotillomania and other obsessive-compulsive-related disorders.
“These underlying feelings play a major role in many psychiatric conditions including TTM and other obsessive-compulsive-related disorders.26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] 26. Nakell S. A healing herd: benefits of psychodynamic group approaches in treating body focused repetitive behaviors. Int J Group Psychother. 2015;65(2):295-306. https://doi.org/10.1521/ijgp.2015. 65.2.295. source
The paper relies on this without support.
The posttreatment relapse rate for habit reversal therapy is high, similar to that of cognitive-behavioral therapy.
“Similar to CBT, posttreatment relapse rate is high with HRT.”
The paper relies on this without support.
Habit reversal therapy does not address all factors that contribute to the development, maintenance, and relapse of trichotillomania.
“In addition, new information about the relationship between emotional regulation processes and the severity of TTM indicates that HRT does not target all the factors that contribute to the development, maintenance, and relapse of TTM.”
The paper relies on this without support.
No specific pharmacological agent has been approved for the treatment of trichotillomania.
“Although no FDA-approved medication for TTM currently exists”
“No specific pharmacological agent has been approved for the treatment in TTM.”
The paper relies on this without support.
No recognized treatment for trichotillomania is available.
“No recognized treatment is available.”
The paper relies on this without support.
Pharmacological treatment for trichotillomania is based on limited trials and case reports.
“Pharmacological treatment is based on limited trials and case reports.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
DSM-5 claim cites the Hallopeau reference
MinorThe DSM-5 classification claim is marked as reference 3, but reference 3 is an 1889 work by Hallopeau rather than the DSM-5.
“Currently, it is classified under obsessive-compulsive spectrum disorder by DSM-5 (Diagnostic and statistical Manual, Edition 5) by American Psychiatric Association.3”
“3. Hallopeau H, Hallopeau M. Alopecie par grattage (trichomanie ou trichotillomanie). Annales de Dermatologie et de Syphiligraphie. 1889; 10:440-444.”
Hallopeau claim cites the DSM reference
MinorThe claim about Hallopeau is marked as reference 2, but reference 2 is the American Psychiatric Association's 2013 manual, not a work by Hallopeau.
“In 1889, François Henri Hallopeau, a French dermatologist, coined this term.2”
“2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing; 2013.”
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- Authors
- Jafferany, M., Mkhoyan, R., Stamu‐O'Brien, C., & Carniciu, S.
- Affiliations
- Central Michigan University (US)
- Dermatology Division Nairi Medical Center Yerevan Armenia
- Dpartment of Psychiatry, NYU School of Medicine Woodhull Medical and Mental Health Center Brooklyn New York USA
- Dermatology Division Center for Research, Diagnosis and Treatment in Diabetes and Metabolic Diseases Corposana Bucharest Romania
- Corresponding author
- Jafferany, Mohammad
- Venue
- Dermatologic Therapy
- Publisher
- Wiley
- Published
- 2020-06-09
- Volume
- 33
- Issue
- 4
- Pages
- e13622-e13622
- ISSN
- 1396-0296 (ISSN-L)
- 1529-8019
- OpenAlex
- W3028212789
- Cited by
- 16
- References
- 32
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 7 · 2022: 3 · 2020: 1
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Dermatologic Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Health Sciences › Medicine › Urology › Hair Growth and Disorders
- Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
- Keywords
- trichotillomania, non-pharmacological treatment, psychotherapy, obsessive-compulsive and related disorders, scalp hair loss, psychodermatosis, anxiety, depression, self-esteem
- MeSH terms
- Adolescent, Adult, Alopecia, Anxiety, Child, Hair Diseases, Humans, Obsessive-Compulsive Disorder, Trichotillomania
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