Skip to main content Accessibility help
Hostname: page-component-559fc8cf4f-z4vvc Total loading time: 0.514 Render date: 2021-03-05T11:11:49.709Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

The Neurobiology of Trichotillomania

Published online by Cambridge University Press:  07 November 2014


The neurobiology of trichotillomania (TTM) has only recently received attention from the neuropsychiatrie community, and the number of studies in this area is limited. Nevertheless, there is tentative support for the hypothesis that serotonergic, dopaminergic, and opioid systems mediate hair-pulling symptoms, and that corticostriatal circuits also play a role. An understanding of the neurobiology of TTM may be of value not only for the treatment of this disorder, but also for other stereotypic behaviors.

Feature Article
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below.


1.Zohar, J, Insel, TR. Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology. Biol Psychiatry. 1987;22:667687.CrossRefGoogle ScholarPubMed
2.Leonard, HL, Swedo, SE, Rapoport, JL, et al.Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents: a double-blind crossover comparison. Arch Gen Psychiatry. 1989;46:10881092.CrossRefGoogle ScholarPubMed
3.Swedo, SE, Leonard, HL, Rapoport, JL, et al.A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med. 1989;321:497501.CrossRefGoogle Scholar
4.O'Sullivan, RA, Christenson, GA, Stein, DJ. Pharmacotherapy of trichotillomania. In: Stein, DJ, Christenson, GA, Hollander, E, eds. Trichotillomania. Washington, DC: American Psychiatric Press. In press.CrossRefGoogle Scholar
5.Pollard, CA, Ibe, IO, Krojanker, DN, et al.Clomipramine treatment of trichotillomania: a follow-up report on four cases. J Clin Psychiatry. 1991;52:128130.Google ScholarPubMed
6.Ninan, PT, Rothbaum, BO, Stipetic, M, Risch, SC. CSF 5HIAA as a predictor of treatment response in trichotillomania. Psychopharmacol Bull. 1992;28:451455.Google Scholar
7.Thoren, P, Asberg, M, Bertilsson, L, et al.Clomipramine treatment of obsessive-compulsive disorder. II. Biochemical aspects. Arch Gen Psychiatry. 1980;37:12891294.CrossRefGoogle ScholarPubMed
8.Stein, DJ, Hollander, E, Cohen, L, Simeon, D, Aronowitz, B. Serotonergic responsivity in trichotillomania: neuroendocrine effects of m-chlorophenylpiperazine. Biol Psychiatry. 1995;37:414416.CrossRefGoogle Scholar
9.Stein, DJ, Hollander, E, Simeon, D, et al.Behavioral responses to m-chlorophenylpiperazine and Clonidine in trichotillomania. J Serotonin Res. 1997;4:1115.Google Scholar
10.Goodman, WK, McDougle, CJ, Price, LH, Riddle, MA, Pauls, DL, Leckman, JF. Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive compulsive disorder? J Clin Psychiatry. 1990;51(suppl):S36S43.Google ScholarPubMed
11.Martin, A, Scahill, L, Vitulani, L, King, A. Stimulant use and trichotillomania (letter). J Am Acad Child Adolesc Psychiatry. 1998;37:349350.CrossRefGoogle Scholar
12.Stein, DJ, Hollander, E. Low-dose pimozide augmentation of serotonin reuptake blockers in the treatment of trichotillomania. J Clin Psychiatry. 1992;53:123126.Google ScholarPubMed
13.van Ameringen, MA, Mancini, CL. Haloperidol in the treatment of trichotillomania. Poster presented at the 149th Annual Meeting of the American Psychiatric Association. May 9th, 1996: New York, NY.Google Scholar
14.Stein, DJ, Bouwer, C, Hawkridge, S, Emsley, RA. Risperidone augmentation of serotonin reuptake inhibitors in obsessive-compulsive and related disorders. J Clin Psychiatry. 1997;58:119122.CrossRefGoogle ScholarPubMed
15.Herman, BH. A possible role of proopiomelanocortin peptides in self-injurious behavior. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14(suppl):S109S139.CrossRefGoogle ScholarPubMed
16.Christenson, GA, Raymond, NC, Faris, PL, et al.Pain thresholds are not elevated in trichotillomania. Biol Psychiatry. 1994;36:347349.CrossRefGoogle Scholar
17.Christenson, GA, Crow, JC, Mackenzie, TB. A placebo controlled, double-blind study of naltrexone for trichotillomania. Presented at the Annual Meeting of the American Psychiatric Association; May 9, 1995; Miami, Fla.Google Scholar
18.Christenson, GA, Mackenzie, TB, Mitchell, JE. Characteristics of 60 adult hair pullers. Am J Psychiatry. 1991;148:365370.Google ScholarPubMed
19.McGehee, FT Jr, Buchanan, GR. Trichophagia and trichobezoar: etiological role of iron deficiency. J Pediatr. 1980;97:946948.CrossRefGoogle Scholar
20.Stein, DJ, Bouwer, C, Van Heerden, B. Pica and the obsessive-compulsive spectrum disorders. S Afr Med J. 1996;86(suppl 12):S1586S1592.Google ScholarPubMed
21.Insel, TR. Toward a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:739744.CrossRefGoogle Scholar
22.Stein, DJ, Coetzer, R, Lee, M, Davids, B, Bouwer, C. Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania. Psychiatry Res. 1997;74:177182.CrossRefGoogle ScholarPubMed
23.O'Sullivan, RA, Rauch, SL, Breiter, HC, et al.Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry. 1997;42:3945.CrossRefGoogle ScholarPubMed
24.Singer, HS, Reiss, AL, Brown, JE, et al.VolumetriC MRI changes in basal ganglia of children with Tourette syndrome. Neurology. 1993;43:950956.CrossRefGoogle Scholar
25.Swedo, SE, Rapoport, JL, Leonard, HL, Schapiro, MB, Rapoport, SI, Grady, CL. Regional cerebral glucose metabolism of women with trichotillomania. Arch Gen Psychiatry. 1991;48:828833.CrossRefGoogle ScholarPubMed
26.Swedo, SE, Schapiro, MB, Grady, CL, et al.Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Arch Gen Psychiatry. 1989;46:518523.CrossRefGoogle ScholarPubMed
27.Stein, DJ, van Heerden, B, Wessels, C, et al. Functional imaging and medication in hairpulling. Presented at the Annual Meeting of the American Psychiatric Association; June 12, 1998; San Diego, Calif.Google Scholar
28.Swedo, SE, Leonard, HL, Mittleman, BB, et al.Identification of children with pediatric autoimmune neuropsychiatriC disorders associated with streptococcal infections by a marker associated with rheumatic fever. Am J Psychiatry. 1997;154:110112.Google Scholar
29.Stein, DJ, Wessels, C, Carr, J, Hawkridge, S, Bouwer, C, Kalis, N. Hair-pulling in a patient with Sydenhams chorea. Am J Psychiatry. 1997;154:1320.Google Scholar
30.Swedo, SE, Leonard, HL, Lenane, MC, Rettew, DC. Trichotillomania: a profile of the disorder from infancy through adulthood. Int J Pediatrics. 1992;7:144150.Google Scholar
31.Rettew, DC, Cheslow, DL, Rapoport, JL, et al.Neuropsychological test performance in trichotillomania: a further link with obsessive-compulsive disorder. J Anxiety Disord. 1991;5:225235.CrossRefGoogle Scholar
32.keuthen, NJ, Savage, CR, O'Sullivan, RL, et al.Neuropsychological functioning in trichotillomania. Biol Psychiatry. 1996;39:747749.CrossRefGoogle ScholarPubMed
33.Stein, DJ, Hollander, E, Simeon, D, et al.Neurological soft signs in female trichotillomania patients, obsessive-compulsive disorder patients, and healthy control subject. J Neuropsychiatry Clin Neurosci. 1994;6:184187.Google Scholar
34.Pauls, DL, Towbin, KE, Leckman, JF, Zahner, GE, Cohen, DJ. Gilles de la Tourette syndrome and obsessive compulsive disorder: evidence supporting a genetic relationship. Arch Gen Psychiatry. 1986;43:11801182.CrossRefGoogle ScholarPubMed
35.Christenson, GA, Mackenzie, TB, Reeve, EA. Familial trichotillomania (letter). Am J Psychiatry. 1992;149:283.CrossRefGoogle Scholar
36.Lenane, MC, Swedo, SE, Rapoport, JL, Leonard, H, Sceery, W, Guroff, JJ. Rates of obsessive compulsive disorder in first degree relatives of patients with trichotillomania: a research note. J Child Psychol Psychiatry. 1992;33:925933.CrossRefGoogle ScholarPubMed
37.Dodman, N, Moon, A, Stein, DJ. Animal models of obsessive-compulsive disorder. In: Hollander, E, Stein, DJ, eds. Obsessive-Compulsive Disorders: Etiology, Diagnosis, Treatment. New York, NY: Marcel Decker; 1997.Google Scholar
38.Rapoport, JL, Ryland, DH, Kriete, M. Drug treatment of canine aeraL lick: an animal model of obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:517521.CrossRefGoogle Scholar
39.Dodman, NH, Shuster, L, White, SD, Court, MH, Parker, D, Dixon, R. Use of narcotic agonists to modify stereotypic self-licking, self-chewing, and scratching behavior in dogs. J Am Vet Med Assoc. 1988;193:815819.Google Scholar
40.Hartmann, L. Cats as possible obsessive-compulsive disorder and medication models (letter). Am J Psychiatry. 1995;152;1236.Google Scholar
41.Swanepoel, N, Lee, E, Stein, DJ. Psychogenic alopecia in a cat: response to clomipramine. S Africa J Vet Med. 1998;69:22.Google Scholar
42.Willemse, T, Mudde, M, Josephy, M, Spruijt, BM. The effect of haloperidol and naloxone on excessive grooming behavior of cats. Eur Neuropsychopharmacol. 1994;4:3945.CrossRefGoogle ScholarPubMed
43.Grindlinger, HM, Ramsay, E. Compulsive feather picking in birds [letter]. Arch Gen Psychiatry. 1991;48:857.CrossRefGoogle Scholar

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 33 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 5th March 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Neurobiology of Trichotillomania
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

The Neurobiology of Trichotillomania
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

The Neurobiology of Trichotillomania
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *