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A Randomized, Waiting-List Controlled Study

Agnes van Minnen, PhD; Kees A. L. Hoogduin, MD, PhD; Ger P. J. Keijsers, PhD; Inge Hellenbrand, MA; Gert-Jan Hendriks, MD

Arch Gen Psychiatry. 2003;60:517-522.

Background  Both behavioral therapy (BT) and serotonin reuptake inhibitors have been reported effective in the treatment of trichotillomania. This study examines the efficacy of BT and fluoxetine hydrochloride compared with a waiting-list (WL) control group.

Methods  Forty-three patients with trichotillomania entered a 12-week randomized, WL-controlled study of BT and fluoxetine (60 mg/d). Forty patients (14 in the BT group, 11 in the fluoxetine group, and 15 in the WL group) completed the trial. Treatment effects were evaluated using the Massachusetts General Hospital Hairpulling Scale, and severity of hair loss was rated by independent assessors. In addition, we measured general symptoms of psychopathologic abnormalities and depression.

Results  For reducing the symptoms of trichotillomania, BT was superior. Patients in the BT group showed a significantly greater reduction in trichotillomania symptoms, higher effect sizes (Massachusetts General Hospital Hairpulling Scale: BT, 3.80; fluoxetine, 0.42; and WL, 1.09), and more clinically significant changes (BT, 64%; fluoxetine, 9%; and WL, 20%) than patients in the fluoxetine and WL groups. For severity of hair loss, a similar trend was also found in favor of the BT group. No significant differences between groups were established for general psychopathologic and depressive symptoms.

Conclusions  Behavioral therapy is highly effective for reducing symptoms of trichotillomania in the short term, whereas fluoxetine is not.

From the Department of Clinical Psychology, University of Nijmegen (Drs van Minnen, Hoogduin, and Keijsers and Ms Hellenbrand), and GGz Nijmegen (Dr Hendriks), Nijmegen, the Netherlands.

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