Single Modality Versus Dual Modality Treatment for Trichotillomania: Sertraline, Behavioral Therapy, or Both?

Darin D. Dougherty, M.D.; Rebecca Loh, B.S.; Michael A. Jenike, M.D.; and Nancy J. Keuthen, Ph.D.

Background: Trichotillomania is a psychiatric condition characterized by chronic hair pulling. Both cognitive behavioral therapy (CBT) and the selective serotonin reuptake inhibitors (SSRIs) have shown promise in the treatment of trichotillomania, with comparison studies favoring CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the efficacy of individual SSRI or CBT treatment to the combination of both treatment modalities.

Method: In this study, which ran from February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were randomly assigned to treatment with sertraline or placebo in a double-blind study design. Following 12 weeks of active pharmacotherapy, subjects not demonstrating significant trichotillomania symptom improvement had habit reversal training (HRT) added to their treatment regimen. Primary outcome measures were the Hair Pulling Scale and the Clinical Global Impressions scale.

Results: Thirteen subjects completing the 22-week study received single modality treatment of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania symptoms in both groups improved, although the dual modality treatment group demonstrated larger gains and were much more likely to reach responder status at final evaluation.

Conclusion: These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.

(J Clin Psychiatry 2006;67:1086-1092)

Corresponding author and reprints: Darin D. Dougherty, M.D., Massachusetts General Hospital, CNY2612, Building 149, 13th Street, Charlestown, MA 02129 (e-mail: ddougherty@partners.org).