Trichotillomania and its treatment: an updated review and recommendations

Abstract

Introduction: Trichotillomania is an impulse control disorder in which individuals fail to resist urges to pull out their own hair and is associated with significant psychiatric comorbidity and functional impairment in affected children, adolescents, and adults. Onset in childhood or adolescence is typical, yet the literature on phenomenology, psychopathology, and treatment outcome involving pediatric samples remains particularly sparse. Efficacious treatments have been developed and found efficacious, most notably cognitive-behavioral interventions known collectively as habit reversal training, although relapse in adults appears to be somewhat common.

Areas covered: Herein, the authors give an overview of the latest developments in the treatment of trichotillomania and provide their own expert recommendations for the management of the condition. This article is based on searches using the PubMed and PsycINFO databases for peer-reviewed articles from 2011 through to April 2025.

Expert opinion: Recent developments in pharmacotherapies, both alone and in combination with cognitive behavioral treatments, hold promise, although further efforts are needed to examine their efficacy, effectiveness, and durability. Dissemination of information about trichotillomania and its treatment remains a critical next step in the field, since many affected individuals and their families experience difficulties with finding local treatment providers with sufficient knowledge to deliver interventions known to reduce hair pulling behaviors and associated symptoms.

Keywords: Impulse control disorder; Trichotillomania; behavior therapy; habit reversal training; psychotherapy.