Hair pulling disorder (HPD; trichotillomania) is characterized by recurrent pulling of hair from the scalp, eyebrows or other parts of the body. Skin picking disorder (SPD) is closely related to HPD and involves re-current picking of the skin. Even though both HPD and SPD are relatively common and potentially severe disorders, health professionals typically know little about them. In the present article, we describe the clinical characteristics of these problems and provide diagnostic guidelines. We also discuss main treatment approaches (drug treatments and behavior therapy) and review research on their efficacy. Results show that behavior therapy (habit reversal) has consistently been shown to be effective, SSRIs seem not to work, but preliminary data suggest that other drugs (e.g. N-Acetylcysteine) may benefit some patients.

Snorrason I,¹ Björgvinsson T²

¹Department of Psychology University of Wisconsin-Milwaukee, ²McLean Hospital / Harvard Medical School.

Table I.  Diagnostic criteria for trichotillomania in DSM-IV

Table II.  Proposed diagnostic criteria for skin picking disorder in DSM-5¹⁴

Table III.  Results from randomized controlled trials examining drug treatments for hair pulling

Table IV.  Results from randomized controlled trials examining drug treatments for skin picking

Table V.  Results from randomized controlled trials examining habit reversal for hair pulling and skin picking