A Systematic Review of Psychological and Pharmacological Interventions for the Management of Trichotillomania in Children and Adolescents

To critically evaluate the existing literature for psychological and pharmacological interventions for the management of trichotillomania in children and adolescents.

A systematic search was conducted in PubMed, OVID Medline, PsychINFO, EMBASE, the Cochrane Central Registry of Controlled Trials and Web of Science for controlled trials from 1990–2017. Studies were included if participants were aged below 18 years with trichotillomania as their primary diagnosis.

From 129 records identified, 6 studies were included in the critical appraisal. Of these, two studies assessed the efficacy of N-acetyl-cysteine and one study assessed the efficacy of methylphenidate, neither showing a difference in symptoms of trichotillomania. One study of habit reversal therapy found a reduction in symptoms of trichotillomania with p-values of <0.001 and <0.002. Of the two studies investigating the efficacy of behavioural therapy, one found a significant improvement in symptoms of trichotillomania (P < 0.01). However, the other, being a low powered study, found no difference.

The literature available contained limited support for psychological or pharmacological therapies. More studies are necessary, particularly in the field of habit reversal therapy and behavioural therapy as these may be potentially effective treatments for children and adolescents with trichotillomania. Moreover, the use of multicentre collaborative efforts to study treatments in this low prevalence, but often highly disabling disorder is warranted.