Editing Trichotillomania (section)

==Treatment==
Treatment is based on a person's age. Most pre-school age children outgrow the condition if it is managed conservatively. In young adults, establishing the diagnosis and raising awareness of the condition is an important reassurance for the family and patient. Non-pharmacological interventions, including [[behavior modification]] programs, may be considered; referrals to psychologists or psychiatrists may be considered when other interventions fail. When trichotillomania begins in adulthood, it is often associated with other [[mental disorder]]s, and referral to a psychologist or psychiatrist for evaluation or treatment is considered best. The hair pulling may resolve when other conditions are treated.<ref name="Sah"/>

===Psychotherapy===
[[Habit reversal training]] (HRT) has the highest rate of success in treating trichotillomania.<ref name="Sah"/> HRT has also been shown to be a successful adjunct to [[medication]] as a way to treat trichotillomania.<ref name="Chamberlain"/><ref name="Woods">{{cite journal | vauthors = Woods DW, Wetterneck CT, Flessner CA | title = A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania | journal = Behaviour Research and Therapy | volume = 44 | issue = 5 | pages = 639–656 | date = May 2006 | pmid = 16039603 | doi = 10.1016/j.brat.2005.05.006 }}</ref> With HRT, the individual is trained to learn to recognize their impulse to pull and also teach them to redirect this impulse. In comparisons of behavioral versus pharmacologic treatment, [[cognitive behavioral therapy]] (including HRT) have shown significant improvement over medication alone.<ref name="Chamberlain"/><ref name="Sah"/> It has also proven effective in treating children.<ref name="Sah"/> [[Biofeedback]], cognitive-behavioral methods, and [[hypnosis]] may improve symptoms.<ref name="Shenefelt2003">{{cite journal | vauthors = Shenefelt PD | title = Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind? | journal = Dermatologic Therapy | volume = 16 | issue = 2 | pages = 114–122 | year = 2003 | pmid = 12919113 | doi = 10.1046/j.1529-8019.2003.01620.x | s2cid = 9242228 | doi-access = free }}</ref> [[Acceptance and commitment therapy]] (ACT) is also demonstrating promise in trichotillomania treatment.<ref>{{cite journal | vauthors = Ruiz FJ |year=2010 |title=A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies |journal=International Journal of Psychology and Psychological Therapy |volume=10 |issue=1 |pages=125–62 |url=http://www.ijpsy.com/volumen10/num1/256.html |url-status=live |archive-url=https://web.archive.org/web/20120223144433/http://www.ijpsy.com/volumen10/num1/256.html |archive-date=2012-02-23 }}</ref> A systematic review from 2012 found tentative evidence for "[[Decoupling for body-focused repetitive behaviors|movement decoupling]]".<ref>{{cite journal | vauthors = Sarris J, Camfield D, Berk M | title = Complementary medicine, self-help, and lifestyle interventions for obsessive compulsive disorder (OCD) and the OCD spectrum: a systematic review | journal = Journal of Affective Disorders | volume = 138 | issue = 3 | pages = 213–221 | date = May 2012 | pmid = 21620478 | doi = 10.1016/j.jad.2011.04.051 }}</ref>

===Medication===
The United States [[Food and Drug Administration]] (FDA) has not approved any medications for trichotillomania treatment.<ref name="Trich">{{cite web|title=Trichotillomania Treatment Options|url=http://www.trichstop.com/treatment|publisher=Trichstop.com|access-date=21 March 2015|url-status=live|archive-url=https://web.archive.org/web/20150302154726/http://www.trichstop.com/treatment|archive-date=2 March 2015}}</ref>

However, some medications have been used to treat trichotillomania, with mixed results. Treatment with [[clomipramine]], a [[tricyclic antidepressant]], was shown in a small [[Blind experiment|double-blind study]] to improve symptoms,<ref name="Swedo">{{cite journal | vauthors = Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL | title = A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling) | journal = The New England Journal of Medicine | volume = 321 | issue = 8 | pages = 497–501 | date = August 1989 | pmid = 2761586 | doi = 10.1056/NEJM198908243210803 }}</ref> but results of other studies on clomipramine for treating trichotillomania have been inconsistent.<ref name="Sah"/> [[Naltrexone]] may be a viable treatment.<ref>{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002485/#adam_001517.disease.treatment|archive-url=https://web.archive.org/web/20130731092435/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002485/|url-status=dead|title=A.D.A.M. Medical Encyclopedia. Trichotillomania Trichotillosis; Compulsive hair pulling. Last reviewed: February 13, 2012.|archive-date=July 31, 2013}}</ref> [[Fluoxetine]] and other [[selective serotonin reuptake inhibitor]]s (SSRIs) have limited usefulness in treating trichotillomania, and can often have significant side effects.<ref name=Christenson91a>{{cite journal | vauthors = Christenson GA, Mackenzie TB, Mitchell JE, Callies AL | title = A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania | journal = The American Journal of Psychiatry | volume = 148 | issue = 11 | pages = 1566–1571 | date = November 1991 | pmid = 1928474 | doi = 10.1176/ajp.148.11.1566 }}</ref> Behavioral therapy has proven more effective when compared to fluoxetine.<ref name="Sah"/> There is little research on the effectiveness of behavioral therapy combined with medication and robust evidence from [[Evidence-based medicine#Assessing the quality of evidence|high-quality studies]] is lacking.<ref name=":1" /> [[N-acetylcysteine]] treatment stemmed from an understanding of glutamate's role in regulation of impulse control.<ref>{{cite journal | vauthors = Grant JE, Odlaug BL, Kim SW | title = N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study | journal = Archives of General Psychiatry | volume = 66 | issue = 7 | pages = 756–763 | date = July 2009 | pmid = 19581567 | doi = 10.1001/archgenpsychiatry.2009.60 | doi-access =  }}</ref>

A study found that [[memantine]], a drug typically used to treat symptoms of Alzheimer's disease, was effective in reducing trichotillomania behaviour. Similar to N-acetylcysteine mentioned above, memantine acts to regulate glutamate levels.<ref name="p978">{{cite journal | last=Grant | first=Jon E. | last2=Chesivoir | first2=Eve | last3=Valle | first3=Stephanie | last4=Ehsan | first4=Dustin | last5=Chamberlain | first5=Samuel R | title=Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder | journal=American Journal of Psychiatry | volume=180 | issue=5 | date=2023-05-01 | issn=0002-953X | doi=10.1176/appi.ajp.20220737 | pages=348–356 | url=https://psychiatryonline.org/doi/10.1176/appi.ajp.20220737 | access-date=2025-05-05}}</ref>

Different medications, depending on the individual, may increase hair pulling.<ref name="Trich"/>

=== Devices ===
Technology can be used to augment habit reversal training or behavioral therapy. Several mobile apps exist to help log behavior and focus on treatment strategies.<ref>{{Cite web|url=http://www.zurinstitute.com/mentalhealthapps_resources.html#trichotillomania|title=Mental Health Apps Resources for Psychologists, MFTs, Counselors, LPCs and Social Workers|website=www.zurinstitute.com|access-date=2016-05-17|url-status=live|archive-url=https://web.archive.org/web/20160510195101/http://www.zurinstitute.com/mentalhealthapps_resources.html#trichotillomania|archive-date=2016-05-10}}</ref> There are also wearable devices that track the position of a user's hands. They produce sound or vibrating notifications so that users can track rates of these events over time.<ref>{{cite web|url=http://www.seattletimes.com/business/technology/brothers-bracelet-lends-hand-with-hair-pulling-condition/|title=Brothers' bracelet helps treat hair-pulling condition| vauthors = Lerman R |date=October 30, 2016|website=Seattle Times|archive-url=https://web.archive.org/web/20170421151829/http://www.seattletimes.com/business/technology/brothers-bracelet-lends-hand-with-hair-pulling-condition/|archive-date=21 April 2017|url-status=live|access-date=23 March 2019}}</ref>