Cognitive Behavioral Treatment of Pediatric Trichotillomania

TTM is a persistent impulse control disorder in which the individual acts on urges to pull out his or her own hair. Onset typically occurs by adolescence, and TTM is often associated with significant functional impairment and distress. CBT is a type of psychotherapy designed to change problematic behaviors and thinking. It includes self-monitoring of hair-pulling urges and homework assignments to practice the use of cognitive and behavioral strategies.

Participants are assigned randomly to receive either CBT or AC for 8 weeks. Participants assigned to CBT receive weekly 1-hour sessions of CBT for 8 weeks; participants assigned to AC receive 6 telephone contacts and 2 in-person sessions for 8 weeks. After 8 weeks, CBT participants who respond to treatment enter Phase II, which lasts an additional 8 weeks and includes 4 in-person maintenance sessions. AC participants who are still symptomatic after 8 weeks are offered CBT.

Inclusion criteria

• Primary diagnosis of Trichotillomania
• Minimum symptom duration of 6 months
• Presence of a stable parent or guardian

Exclusion criteria

• Other primary psychiatric diagnosis
• Bipolar illness, pervasive developmental disorder, thought disorder, current major depression, ADD/ADHD
• Concurrent psychotherapy
• Currently receiving psychotropic medications