Background: Trichotillomania is a challenging from of body-focused repetitive disorders. Moved in the clinical classification system from impulse control disorders to obsessive compulsive disorders spectrum and given the comorbidity with other psychiatric disorders such OCD, all of which adds up to the complex etiology hence, challenging management.

Methods and Materials:

First step is to apply hair oil or hair cream all over the scalp followed by combing the scalp equally in all directions in the morning to make same feeling all over the scalp.

Second step is to cover the scalp tightly with a headscarf preferably a favorite one. The scarf will be the first barrier to stop the patients’ fingers.

Third step using the hair combing as a meaningful competing response whenever the patients gets an urge to pull hair out and if touching the scarf is not stopping the hair pulling, then removing the scarf followed by hair combing would replace the hair pulling. Pharmacological interventions used with our technique included SSRIs, SNRIs, TCAs and glutathione which reflects the broad background for the chemical etiology.

Results: In eight female patients with ages from 18 to 36 years, for an average period of ten weeks, with scalp as the hair pulling area and according the CGI scale the improvement was around 50% improvement subjective sense of improvement with regards to frequency of hair pulling and area of baldness.

Conclusion: The meaningful competing response when replacing the usual competing response added to pharmacological intervention is worth studying more as possible alternative to the usual competing response.

TBA