Cognitive Behavior Therapy in Trichotillomania

발모광 아동에서 인지행동치료

  • Cho, Hwan-Il (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Do, Jin-A (Clinical Psychology Lab, Dankook Medical Center) ;
  • Kim, Yeon-Soo (C&U Dermatology Clinic) ;
  • Lim, Myung-Ho (Department of Psychiatry, College of Medicine, Dankook University) ;
  • Kim, Hyun-Woo (Department of Psychiatry, College of Medicine, Dankook University)
  • 조환일 (단국대학교 의과대학 정신과학교실) ;
  • 도진아 (단국대학교 의료원 임상심리실) ;
  • 김연수 (씨앤유 피부과) ;
  • 임명호 (단국대학교 의과대학 정신과학교실) ;
  • 김현우 (단국대학교 의과대학 정신과학교실)
  • Received : 2009.05.11
  • Accepted : 2009.07.02
  • Published : 2009.10.30

Abstract

Trichotillomania is a neuropsychiatric disorder characterized by repetitive pulling out of one's hair. We present a trichotillomania case study illustrating the effectiveness of habit reversal training, which has recently been found, in western countries, to be a very effective cognitive behavioral treatment. The refractory patient in our study had previously received 1 year of drug treatment and psychiatric consultation for the disorder. We administered 10 habit reversal training sessions, which was followed by an obvious improvement in the patient's trichotillomania symptoms. Our observations indicate that habit reversal training might be effective in the treatment of trichotillomania.

Keywords

References

  1. American Psychiatric Association. Diagnostics and Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington: American Psychiatric Association;2000.
  2. Hallopeau H. Alopecie par grattage (trichomanie ou trichotillomanie). Ann Dermatol Syphiligr (Paris) 1989;10:440-441.
  3. Tay YK, Levy ML, Metry DW. Trichotillomania in childhood: case series and review. Pediatrics 2004;113:e494-e498. https://doi.org/10.1542/peds.113.5.e494
  4. Christenson GA, Pyle RL, Mitchell JE. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry 1991;52:415-417.
  5. Azrin NH, Nunn RG. Habit Control in a Day. New York: Simon & Schuster;1977.
  6. King RA, Scahill L, Vitulano LA, Schwab-Stone M, Tercyak KP Jr, Riddle MA. Childhood trichotillomania: clinical phenomenology, comorbidity, and family genetics. J Am Acad Child Adolesc Psychiatry 1995;34:1451-1459. https://doi.org/10.1097/00004583-199511000-00011
  7. Christenson GA, Mackenzie TB, Mitchell JE. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry 1991;148:365-370. https://doi.org/10.1176/ajp.148.3.365
  8. Vaughan ED Jr, Sawyers JL, Scott HW Jr. The Rapunzel syndrome. An unusual complication of intestinal bezoar. Surgery 1968;63:339-343.
  9. Stein DJ, Chamberlain SR, Fineberg N. An A-B-C model of habit disorders: hair-pulling, skin-picking, and other stereotypic conditions. CNS Spectr 2006;11:824-827. https://doi.org/10.1017/S1092852900014978
  10. Gershuny BS, Keuthen NJ, Gentes EL, Russo AR, Emmott EC, Jameson M, et al. Current posttraumatic stress disorder and history of trauma in trichotillomania. J Clin Psychol 2006; 62:1521-1529. https://doi.org/10.1002/jclp.20303
  11. Oranje AP, Peereboom-Wynia JDR, De Raeymaecker DMJ. Trichotillomania in childhood. J Am Acad Dermatol 1986;15:614-619. https://doi.org/10.1016/S0190-9622(86)70213-2
  12. Mansueto CS. Typography and phenomenology of trichotillomania. Paper presented at: Annual Convention of the Association for the Advancement of Behavior Therapy; 1990 Nov 6-9; San Francisco.
  13. Soriano JL, O'Sullivan RL, Baer L, Phillips KA, McNally RJ, Jenike MA. Trichotillomania and self-esteem: a survey of 62 hair pullers. J Clin Psychiatry 1996;57:77-82.
  14. Swedo SE, Leonard HL. Trichotillomania: an obsessive compulsive spectrum disorder? Psychiatr Clin North Am 1992;15:777-791.
  15. Hautmann G, Hercogova J, Lotti T. Trichotillomania. J Am Acad Dermatol 2002;46:807-821. https://doi.org/10.1067/mjd.2002.122749
  16. Stein DJ, Hollander E, Cohen L, Simeon D, Aronowitz B. Serotonergic responsivity in trichotillomania: neuroendocrine effects of mchlorophenylpiperazine. Biol Psychiatry 1995;37:414-416. https://doi.org/10.1016/0006-3223(94)00199-D
  17. Stein DJ, Bouwer C, Maud CM. Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania. Eur Arch Psychiatry Clin Neurosci 1997;247:234-236. https://doi.org/10.1007/BF02900220
  18. van Minnen A, Hoogduin KA, Keijsers GP, Hellenbrand I, Hendriks GJ. Treatment of trichotillomania with behavioral therapy or fluoxetine: A randomized, waiting-list controlled study. Arch Gen Psychiatry 2003;60:517-522. https://doi.org/10.1001/archpsyc.60.5.517
  19. Dougherty DD, Loh R, Jenike MA, Keuthen NJ. Single modality versus dual modality treatment for trichotillomania: sertraline, behavioral therapy, or both? J Clin Psychiatry 2006;67:1086-1092. https://doi.org/10.4088/JCP.v67n0711
  20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington: American Psychiatric Association;1994.
  21. Tolin DF, Diefenbach GJ, Flessner CA, Franklin ME, Keuthen NJ, Moore P, et al. Trichotillomania Learning Center Scientific Advisory Board. The trichotillomania scale for children: development and validation. Child Psychiatry Hum Dev 2008;39:331-349. https://doi.org/10.1007/s10578-007-0092-3
  22. Guy W. ECDU Asessment Manual for Psychopharmacology, Revised. Bethesda: US Department of Health, Education, and Welfare;1976.
  23. Oh KJ. Parent training treatment effect study in Korean ADHD patients. Kor J Clin Psychol 1994;13:217-233.
  24. Kim YS, So YK, Noh JS, Choi NK, Kim SJ, Koh YJ. Normative data on the Korean ADHD Rating Scales (K-ARS) for Parent and Teacher. Kor J Neuropsychiatr Assoc 2003;42:352-359.
  25. Kovacs M. The children's depression inventory: A self-rated depression scale for school-aged youngsters. Unpublished manuscript. University of Pittsburgh;1983.
  26. Cho SC, Choi JS. Development of Korean form of the statetrait anxiety inventory for children. J Seoul Psychitry 1989;14:150-157.
  27. Trichotillomania Learning Center. http://www.trich.org/home/
  28. Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med 1989;321:497-501. https://doi.org/10.1056/NEJM198908243210803
  29. Christenson GA, Mackenzie TB, Mitchell JE, Callies AL. A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry 1991;148:1566-1571. https://doi.org/10.1176/ajp.148.11.1566
  30. Streichenwein SM, Thornby JI. A long-term, double-blind, placebo-controlled crossover trial of the efficacy of fluoxetine for trichotillomania. Am J Psychiatry 1995;152:1192-1196. https://doi.org/10.1176/ajp.152.8.1192
  31. Stein DJ, Bouwer C, Maud CM. Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania. Eur Arch Psychiatry Clin Neurosci 1997;247:234-236. https://doi.org/10.1007/BF02900220
  32. Ninan PT, Knight B, Kirk L, Rothbaum BO, Kelsey J, Nemeroff CB. A controlled trial of venlafaxine in trichotillomania: interim phase I results. Psychopharmacol Bull 1998;34:221-224.
  33. Stewart RS, Nejtek VA. An open-label, flexible-dose study of olanzapine in the treatment of trichotillomania. J Clin Psychiatry 2003;64:49-52. https://doi.org/10.4088/JCP.v64n0110
  34. Lochner C, Seedat S, Niehaus DJ, Stein DJ. Topiramate in the treatment of trichotillomania: an open-label pilot study. Int Clin Psychopharmacol 2006;21:255-259. https://doi.org/10.1097/00004850-200609000-00002
  35. Azrin NH, Nunn RG, Franz SE. Treatment of trichotillomania: a comparative study of habit reversal and negative practice training. J Behav Ther Exp Psychiatry 1980;11:13-20. https://doi.org/10.1016/0005-7916(80)90045-2
  36. Blum NJ, Barone VJ, Friman PC. A simplified behavioral treatment for trichotillomania: report of two cases. Pediatrics 1993;91:993-995.
  37. Rapp JT, Miltenberger RG, Long ES, Elliott AJ, Lumley VA. Simplified habit reversal treatment for chronic hair pulling in three adolescents: a clinical replication with direct observation. J Appl Behav Anal 1998;312:299-302.
  38. Elliott AJ, Fuqua RW. Behavioral interventions for trichotillomania. In: Woods DW, Miltenberger RG, editors. Tic Disorders, Trichotillomania, and Other Repetitive Behavior Disorders: Behavioral Approaches to Analysis and Treatment. Boston: Kluwer Academic;2001. p.151-170.
  39. Ninan PT, Rothbaum BD, Marstellar FA, Knight BT, Eccard MB. A placebo-controlled trial of cognitive behavioral therapy and clomipramine in trichotillomania. J Clin Psychiatry 2000;61:47-50. https://doi.org/10.4088/JCP.v61n0111
  40. Cohen LJ, Stein DJ, Simeon D, Spadaccine E, Rosen J, Aronowitz B, et al. Clinical profile, comorbidity, and treatment history in 123 hair pullers: a survey study. J Clin Psychiatry 1995; 56:319-326.
  41. Greenberg R, Sarner CA. Trichtillomania: symptom and syndrome. Arch Gen Psychiatry 1965;12:482-489. https://doi.org/10.1001/archpsyc.1965.01720350050007