Combination therapy treats obsessive hair pulling

Behavioural therapy plus medication is effective in treating trichotillomania, a psychiatric disorder characterised by obsessive hair pulling. Trichotillomania is related to obsessive-compulsive disorder (OCD), and does not improve on its own, if left untreated. The disorder can interfere with a person's personal relationships and lead people to avoid social and public activities. Researchers from the Massachusetts General Hospital in Boston found that the combination of behavioural therapy and medication is better than either one alone. A special type of cognitive behavioural therapy known as habit reversal training (HRT) has shown to be effective for treating this disorder, as have drugs used for treating depression and OCD known as selective serotonin reuptake inhibitors (SSRIs). Doctors generally use both treatments in patients with trichotillomania. The researchers investigated whether the combination might be more effective than either treatment alone. For this they randomly assigned a group of trichotillomania patients to the SSRI - sertraline or a placebo. Those who did not show improvement after 12 weeks were given HRT along with the drug for an additional 10 weeks. Of the 24 patients who completed the study, 13 received sertraline or HRT only and 11 received both. While improvements were seen in both groups, they were significantly greater among the patients given sertraline plus HRT. The researchers failed to see significant effects of treatment on patients' quality of life or function, but this, is likely because of the small size of the study. The trend is certainly toward improvement in function and quality of life. Further study is needed, to determine if the benefits of combination treatment for trichotillomania extend over the long term, and to understand the mechanism by which the combination exerts its effects.