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General Medical Questions
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Question : Is there an effective treatment for hair pulling?
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The Trusted Source
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Howard LeWine, M.D.

Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.

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October 10, 2012
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A:

Hair pulling is more common than many believe. It may affect up to 3.5% of adults, although some experts say the number is closer to 1%. The older name for this condition is trichotillomania. But the more modern term is “hair pulling disorder.”

People with this problem can’t resist pulling out their hair. The behavior may relieve their tension. Even give pleasure. The hair pulling may come and go with stress. Or it may become a constant habit.

Hair pulling can interfere seriously with work, school and career advancement. Some sufferers avoid both intimate relationships and going out in public out of shame. Many need treatment for anxiety or depression. Some turn to alcohol or illicit drugs for relief.

No one best treatment is available. Habit reversal training, a type of cognitive behavioral therapy, can be effective. Drugs for obsessive compulsive disorder (OCD) may also help.

Antidepressant options like fluoxetine (Prozac), sertraline (Zoloft) or clomipramine may help. If one drug alone is not helpful, then it’s often worth adding a second drug.

One recent article showed that a combination of psychotherapy and drug therapy gave the most relief.

Even if the hair-pulling itself is not significantly improved by treatment, it’s worth treating anxiety or depression if that is part of the picture. Psychotherapy can be supportive and can help a person cope with shame. There are also support groups available. One such group is the Trichotillomania Learning Center (www.trich.org).

Despite the limits of our knowledge about this disorder, there does seem to be growing awareness of it. Research can lead to better treatments. In the meantime, getting past the shame and living a full life with the disorder may be the best strategy.

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