Nonpharmacological therapies for trichotillomania.

Contrary to prior belief, trichotillomania is not a rare condition and may occasionally prove resistant to therapy. Although for practical reasons, pharmacological agents are used as first-line treatment, there are a variety of nonpharmacological therapeutic approaches available. In the pediatric age-group - in which the disorder is common - there is a strong tendency among clinicians and parents towards the avoidance of medications and the use of nonpharmacological strategies as the treatment of choice. This article reviews the multimodal approach to the trichotillomania patient and emphasizes the efficacy and safety of different behavioral, hypnotic, educational and family therapy techniques. Further controlled outcome studies are needed to substantiate this clinical impression.