Examining Behavior Therapy for Trichotillomania in Children and Adolescents

Trichotillomania (TTM) is a chronic impulse control disorder that causes people to pull out
their own hair. TTM typically develops in late childhood or early adolescence. It has been
suggested that, like with obsessive-compulsive disorder, early identification and treatment
of TTM might prevent the disorder and other co-occurring disorders in adults. The researchers
in this study have developed the first treatment for TTM to target children and adolescents.
Preliminary trials of this treatment, called behavior therapy (BT), indicate efficacy. This
study is a larger, more rigorous examination of whether BT can successfully treat children
and adolescents with TTM.

Participation in this study will be divided into two phases, each lasting 8 weeks. Follow-up
visits will occur 3 and 6 months after completing treatment. In Phase 1, participants will be
randomly assigned to receive either BT or supportive counseling (SC) for their TTM. Both
groups of participants will complete eight weekly study visits. Those receiving BT will be
encouraged to identify situations in which hair pulling is likely to occur and use behavioral
techniques to resist urges to pull their hair. BT will also involve self-monitoring and
homework throughout the week. Those receiving SC will discuss ways to minimize interference
of hair pulling with everyday life and receive education and emotional support from a study
therapist—but will not be taught specific behavioral techniques. After 8 weeks, participants
will be evaluated to determine whether treatment is helping them. If participants are
receiving BT and showing reduction in symptoms, they will continue to Phase 2, which involves
four maintenance sessions of BT over 8 weeks. If participants receiving BT are not responding
to treatment, they will be given referrals to other services. Participants receiving SC will
end their participation after 8 weeks, and those not responding to treatment will be offered
BT.

Study assessments will be completed at baseline, after Phase 1, after Phase 2, and at 3- and
6-month follow-ups. These assessments will include a clinical interview, questionnaires about
symptoms, and family assessment measures.

Inclusion Criteria:

- Diagnosis or symptoms of trichotillomania

- Presence of stable parent or guardian

Exclusion Criteria:

- Presence of another primary or co-primary psychiatric disorder that requires
initiation of different active current treatment

- Current use of psychotropic medication (participants may be able to stop taking
medications to start with study)