A systematic review and meta-analysis of behaviourally based psychological interventions and pharmacological interventions for trichotillomania

Background: Trichotillomania (hair-pulling disorder) is a debilitating and distressing disorder associated with great secrecy and shame. A lack of understanding regarding interventions for Trichotillomania contributes to poor routine outcomes for the disorder. Method: This systematic review and meta-analysis assessed the efficacy of behaviourally based psychological interventions and pharmacological interventions for trichotillomania compared to a range of control groups. Participants were adults who have been diagnosed with trichotillomania. A systematic search was conducted of the Cochrane library, EBSCOhost, MEDLINE before 1966, and Google Scholar for relevant randomised controlled trials. Results: Of the total 462 records identified, 12 studies were included in the quantitative synthesis, and nine studies were included in meta-analyses. Conclusions: Analyses revealed that-from medication approaches-fluoxetine was not found to be efficacious. However, N-acetyl cysteine, clomipramine, and olanzapine showed potential for the treatment of trichotillomania. Regarding psychotherapy, behaviour therapy showed superior efficacy when compared to a passive control group. However, when behaviour therapy was compared to an active control group (progressive muscle relaxation, supportive therapy), both conditions showed similar efficacy in treating trichotillomania. It was concluded that the psychological mechanisms in trichotillomania may be more complex than the behavioural model indicates. Implications and limitations are discussed.