The DOI matches its Crossref record.
A Placebo-Controlled Trial of Cognitive-Behavioral Therapy and Clomipramine in Trichotillomania
Abstract
BACKGROUND: The major treatments reported to be effective in the treatment of trichotillomania are cognitive-behavioral therapy (CBT) with habit reversal and serotonin-norepinephrine reuptake inhibitors such as clomipramine. However, the 2 treatments have not been previously compared with each other. This study examines the efficacy of CBT and clomipramine compared with placebo in the treatment of trichotillomania. METHOD: Twenty-three patients with trichotillomania as determined by the Structured Clinical Interview for DSM-III-R entered and 16 completed a 9-week, placebo-controlled, randomized, parallel-treatment study of CBT and clomipramine. Efficacy was evaluated by the Trichotillomania Severity Scale, the Trichotillomania Impairment Scale, and the Clinical Global Impressions-Improvement scale, which were conducted by an independent assessor blinded to the treatment condition. RESULTS: CBT had a dramatic effect in reducing symptoms of trichotillomania and was significantly more effective than clomipramine (p = .016) or placebo (p = .026). Clomipramine resulted in symptom reduction greater than that with placebo, but the difference fell short of statistical significance. Placebo response was minimal. CONCLUSION: Clinicians should be aware of the potential treatments available for trichotillomania. A larger and more definitive study comparing CBT and a serotonin-norepinephrine reuptake inhibitor is indicated.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“These findings are in line with most previous research (Woods et al., 2006b; Ninan et al., 2000; van Minnen et al., 2003; Schuck et al., 2011) and call for further development and improvement of TTM- and SPD-treatments.”
From Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial (2022) · cites this paper as Ninan et al., 2000
Citations
Cited by
Sorted by citations
Items 201–300 of 300
Trikotillomani: Tanı, Farmakoterapi ve Kognitif Davranışçı Terapisi
Konkan, R., Şenormancı, Ö., & Sungur, M. Z. (2011) · Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology · doi:10.5455/bcp.20110904062905 · Cited by 1
Pharmacologic Treatment of Impulse Control Disorders
Grant, J. E., & Potenza, M. N. (2008) · Psychopharm Review · doi:10.1097/01.idt.0000334723.91820.15 · Cited by 3
“Ninan and colleagues conducted a 9-week, placebo-controlled, randomized, parallel-treatment trial in 23 subjects comparing clomipramine with cognitive-behavioral therapy (CBT).(26) CBT, administered as a modified manualized treatment based on habit reversal therapy, was significantly more effective in reducing the sym…”
Nicht-stoffgebundene Süchte, Impulskontrollstörungen
Ebert, D., & Hecht, H. (2012) · Elsevier eBooks · doi:10.1016/b978-3-437-22483-6.10022-1 · Cited by 1
Development of a measure of cognitions and beliefs in trichotillomania
Rehm, I. C. (2016) · Swinburne figshare (Swinburne University of Technology) · doi:10.25916/sut.26269711 · Cited by 1
Chapter 14. Obsessive-Compulsive and Related Disorders
Dougherty, D. D., Wilhelm, S., & Jenike, M. A. (2019) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615372980.lr14 · Cited by 1
Rehm, I. C., Moulding, R., & Nedeljkovic, M. (2024) · Australian Psychologist · doi:10.1080/00050067.2024.2376881 · Cited by 3
“For instance, some studies of cognitive-behavioural therapy (CBT) for HPD (e.g., Lerner et al., 1998; Ninan et al., 2000) incorporated cognitive restructuring and thought-stopping techniques, but did not specify the content or function of the cognitions purported to precipitate and maintain hair…”
Psychiatry Review and Canadian Certification Exam Preparation Guide
Parthasarathi, U., & Hategan, A. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333 · Cited by 1
Blackman, K., Odom, A. J., Williamson, B., Miller, M. A., Tewari, M., & Weismantel, D. (2014) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.47.3.b · Cited by 2
Çoban, M. C. (2021) · Turk Turizm Arastirmalari Dergisi · doi:10.26677/tr1010.2021.901 · Cited by 1
Franklin, M. E., Tolin, D. F., & Diefenbach, G. J. (2007) · Elsevier eBooks · doi:10.1016/b978-008044701-8/50010-3 · Cited by 18
Nicht stoffgebundene Süchte, Impulskontrollstörungen
Ebert, D., & Hecht, H. (2019) · Elsevier eBooks · doi:10.1016/b978-3-437-22485-0.00022-1 · Cited by 1
Chaudhury, S., Raju, M., Salujha, S., Srivastava, K., & Choudhary, A. K. (2003) · Medical Journal Armed Forces India · doi:10.1016/s0377-1237(03)80114-4 · Cited by 1
Chapter 1. Functional Neuroanatomy
Harel, B. T., & Tranel, D. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg01 · Cited by 1
Trichotillomania: Clinical Aspects
Walther, M. R., Tucker, B. T. P., & Woods, D. W. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511711930.009 · Cited by 1
Nicht stoffgebundene Süchte, Impulskontrollstörungen
Ebert, D., & Hecht, H. (2015) · Elsevier eBooks · doi:10.1016/b978-3-437-22484-3.00022-0 · Cited by 1
Cognitive-Behavioral Therapy: The Truth Behind the Allegations
Wydo, M. R. (2001) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1023/a:1012560930956 · Cited by 1
Stewart, S. E., Dougherty, D. D., Wilhelm, S., Keuthen, N. J., & Jenike, M. A. (2008) · Elsevier eBooks · doi:10.1016/b978-0-323-04743-2.50035-4 · Cited by 1
Mechanisms of Treatments for Trichotillomania (Hair Pulling Disorder)
Brennan, E., Francazio, S., Murphy, Y. E., & Flessner, C. (2017) · doi:10.1002/9781118877142.ch20 · Cited by 1
Biological Models and Treatments for Obsessive‐Compulsive Related Disorders for Adults
Hudak, R., Borue, X., & Sharma, M. (2017) · Wiley eBooks · doi:10.1002/9781118890233.ch59 · Cited by 1
Twohig, M. P., Bluett, E. J., Morrison, K. L., & Woidneck, M. R. (2013) · doi:10.1002/9781118528563.wbcbt10 · Cited by 1
Cognitive Behavior Therapy in Trichotillomania
Cho, H.-I., Do, J.-A., Kim, Y. S., Lim, M.-H., & Kim, H. (2009)
Multimodale Verhaltenstherapie versus Paroxetin-Behandlung bei Trichotillomanie
Neudecker, A. (2006)
Trichotillomanie in der Praxis
Jurgens, V., Sosic-Vasic, Z., & Vasic, N. (2013) · Nervenheilkunde · doi:10.1055/s-0038-1628536
“Studien (24, 25) konnte gezeigt werden, dass kognitive Verhaltenstherapie unter Integrati-”
BackgroundRecent Japanese Studies of Trichotillomania
Oguchi, T. (2006) · Journal of Rural Medicine · doi:10.2185/jrm.1.2_1
13 Stoornissen in de impulscontrole
Hoogduin, C. A. L., & Verbraak, M. J. P. M. (2008) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6632-3_13
Keuthen, N., & Usmani, A. (2016) · Springer eBooks · doi:10.1007/978-1-4939-2605-3_9 · Cited by 2
Hud og psykisk helse : hvordan forstå og behandle den psykodermatologiske pasient?
Dahl, A. G. G. (2011) · NORA - Norwegian Open Research Archives
Treatment of Obsessive- Compulsive and Related
Stein, D. J. (2014)
The use of habit reversal training in the treatment of trichotillomania: a single subject design
Jones, C. M. (2004) · Rowan Digitals Works (Rowan University)
Trichotillomania and Traction Alopecia
Uzunçakmak, T., Kayıran, M., Tekin, B., & Cebeci, F. (2017) · InTech eBooks · doi:10.5772/66746 · Cited by 12
“Clomipramine was found to be more effective than placebo, although 3 of 10 participants receiving clomipramine dropped out because of drug‐related adverse effects [21].”
Background20 Stoornissen in de impulscontrole
Hoogduin, C. A. L., Keijsers, G. P. J., van Minnen, A., & Verbraak, M. J. P. M. (2006) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-9244-5_20 · Cited by 3
Trichotillomania and Excoriation Disorder
Lee, E. B., Ong, C. W., & Twohig, M. P. (2018) · Springer eBooks · doi:10.1007/978-3-319-70539-2_41
The Assessment and Treatment of Trichotillomania
Christenson, G. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195389715.013.0095
LA RELAZIONE TERAPEUTICA NEI DISTURBI FOBICI E OSSESSIVO-COMPULSIVI
M-Psi, S., & Clínica, P. (2015)
Dombrowski, S. C., Gischlar, K. L., Mrazik, M., & Gordon, J. (2011) · Springer eBooks · doi:10.1007/978-1-4419-9970-2_7
Siek, A., Makarewicz, A., Łobejko, Ł., Gralewska, A., Tomaka, J., Szymańska-Piekarczyk, J., Siembida, J. M., & Juchnowicz, H. (2017) · Current Problems of Psychiatry · doi:10.1515/cpp-2017-0029
Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial
Lee, E. B. (2018) · Digital Commons - USU (Utah State University) · doi:10.13140/rg.2.2.35306.21448
Sachdev, R. A., Ruparelia, R., Reid, J. E., Mpavenda, D., Cinosi, E., & Fineberg, N. A. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108164313.016 · Cited by 1
Very Late Onset "Trichotillomania": A Case Report
Aslan, M., Hocaoğlu, Ç., Yüksel, D., & Dılek, N. (2018) · Meandros Medical And Dental Journal · doi:10.4274/meandros.2054
Trichotillomania: Great Impact, Low Clinician Recognition
Kaplan, A. (2006)
From OC Spectrum to Anxiety Disorders
Hellberg, S. N., Jacoby, R. J., & Wilhelm, S. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-30687-8_6
Nicht-stoffgebundene Süchte, Impulskontrollstörungen
Ebert, D., & Hecht, H. (2009) · Elsevier eBooks · doi:10.1016/b978-343722481-2.50026-x
Trichotillomania: Hair Pulling Disorder
Olusoji, E. B., Adesina, M. A., & Kanmodi, K. K. (2018) · doi:10.5281/zenodo.19059437 · Cited by 1
Clinical pharmacology of psychotropic drugs
Patat, A. A. (2000) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/1099-1077(200007)15:5 · Cited by 16
(2017) · International Journal of Science and Research (IJSR) · doi:10.21275/art20163847
Błoch, M. (2021) · Encyclopedia of Autism Spectrum Disorders · doi:10.1007/978-3-319-91280-6_1839
Bloch, M. H. (2014) · Springer eBooks · doi:10.1007/978-3-642-27772-6_383-2
Session 8: Practicing Acceptance and Commitment Therapy (ACT)
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0008
Client Forms, Graphs, and Worksheets
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0002
Modifications for Working with Adolescents
Petersen, J. M. (2023) · doi:10.1093/med-psych/9780197670309.003.0011
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0005
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0002
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0004
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0003
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0001
Session 5: Acceptance of Pulling-Related Inner Experiences
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0006
Sessions 6 and 7: Defusion from Your Inner Experiences: You Are Not Your Urges to Pull
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0007
Session 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0009
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0003
Session 10: Review and Relapse Prevention
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0010
Session 3: Increasing Motivation for Treatment Through Values
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0004
Treatment of Trichotillomania and Skin-Picking Disorder
Franklin, M. E., Antinoro, D., Ricketts, E. J., & Woods, D. W. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.25
Chapter 15. Dissociative Disorders
Maldonado, J. R., & Spiegel, D. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg15
Chapter 7. Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Ursano, A. M., Kartheiser, P. H., & Barnhill, L. J. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg07
Chapter 4. The Psychiatric Interview and Mental Status Examination
ANDREWS, L. B., & Ovsiew, F. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg04
Chapter 3. Psychiatry and the Law
SIMON, R. I., Shuman, D. W., Hategan, A., & Parthasarathi, U. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg03
Minzenberg, M., Yoon, J. H., & Carter, C. S. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg10
Chapter 23. Psychodynamic Psychotherapy
Ursano, R. J., Sonnenberg, S. M., & Lazar, S. G. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg23
Hollander, E., Simeon, D., & Parthasarathi, U. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg12
Chapter 6. Clinical Neuroimaging
Hurley, R. A., Fisher, R. E., & Taber, K. H. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg06
Chapter 13. Somatoform Disorders
Yutzy, S. H., & Parish, B. S. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg13
Chapter 22. Nonpharmacological Somatic Treatments
George, M. S., Nahas, Z. H., Borckardt, J. J., Anderson, B., & Foust, M. J. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg22
Joska, J. A., Stein, D. J., & Parthasarathi, U. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg11
Wright, J. H., Thase, M. E., & Beck, A. T. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg24
Chapter 19. Impulse-Control Disorders Not Elsewhere Classified
Hollander, E., Berlin, H. A., & Stein, D. J. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg19
Chapter 17. Gender Identity Disorders and Paraphilias
BECKER, J. V., JOHNSON, B. R., Parthasarathi, U., & Hategan, A. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg17
Halmi, K. A., & Hategan, A. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg18
Chapter 14. Factitious Disorder and Malingering
McDermott, B. E., Leamon, M. H., Feldman, M. D., & Scott, C. L. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg14
Chapter 21. Psychopharmacology
Martínez, M., Marangell, L. B., Martinez, J. M., & Hategan, A. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg21
Chapter 5. Laboratory Testing in Psychiatry
KIM, H. F., Schulz, P. E., Wilde, E. A., & Yudofsky, S. C. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg05
Gaw, A. C. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg02
Chapter 9. Substance-Related Disorders
Leamon, M. H., Wright, T. M., Myrick, H., & Parthasarathi, U. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg09
Chapter 8. Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Bourgeois, J. A., Seaman, J. S., Servis, M. E., & Hategan, A. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg08
BECKER, J. V., & Stinson, J. D. (2012) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378333.lg16
Queiroz, C., Barbosa, J. D. V., Soares, M. B. P., Rodrigues, L. D. S., Schooley, R. T., & Badaró, R. J. D. S. (2025) · International Journal of Clinical Dermatology · doi:10.11648/j.ijcd.20250801.13
Fisak, B., Shorb, C., Patel, D., & Ezcurra, V. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.02.029
Trikotillomani (Saç Yolma Bozukluğu)
Tamam, L., & Yıldız, M. (2026) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.4069
Paediatric acute-onset neuropsychiatric syndrome (PANS) with trichotillomania
Peter, C., Pavaskar, M. S., Sharma, A., & Jilani, A. Q. (2026) · BMJ Case Reports · doi:10.1136/bcr-2025-271869
TRICHOTILLOMANIA AND EXCORIATION DISORDER: COMPARATIVE EFFICACY OF HABIT REVERSAL TRAINING
Machaalani, R. M., Pires, P. P. G., Pastorello, E., Thome, A. K. D. U., França, G., Kensy, A. F., Cremonez, C. Z., de Azevedo, F. R. S., de Arruda, M. F. G. P., da Silva, P. B. G., et al. (2026) · Revista de Geopolítica · doi:10.56238/revgeov17n10-036
Greining og meðferð hárplokkunar- og húðkroppunaráráttu
Snorrason, Í., & Bjorgvinsson, T. (2012) · Læknablaðið · doi:10.17992/lbl.2012.03.421
Metadata
- Authors
- Ninan, P. T., Rothbaum, B. O., Marsteller, F. A., Knight, B. T., & Eccard, M. B.
- Affiliations
- Emory University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2000-01-15
- Volume
- 61
- Issue
- 1
- Pages
- 47-50
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2993744382
- Cited by
- 303
- References
- 0
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 25 · 2022: 2 · 2021: 8 · 2020: 8 · 2019: 15 · 2018: 14 · 2017: 13 · 2016: 10 · 2015: 17 · 2014: 14 · 2013: 10 · 2012: 37
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (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, cognitive behavioral therapy, clomipramine, habit reversal, serotonin-norepinephrine reuptake inhibitors, placebo response, treatment efficacy
- MeSH terms
- Adult, Clomipramine, Double-Blind Method, Female, Humans, Male, Middle Aged, Placebos, Psychiatric Status Rating Scales, Severity of Illness Index, Trichotillomania, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
