A 19-year-old woman presents with recurrent, distressing urges to pull out her hair from the scalp and eyebrows, resulting in noticeable hair loss. She denies any skin disorder and experiences gratification after pulling. The MOST effective first-line treatment is:

• A SSRIs alone
• B N-acetylcysteine alone (glutamate modulator)
• C Habit Reversal Training (HRT) — a specific CBT technique ✓
• D Low-dose antipsychotic

Explanation

Trichotillomania (Hair-Pulling Disorder, DSM-5) is best treated with Habit Reversal Training (HRT), a specific behavioural intervention involving awareness training, competing response training, and social support. HRT has the strongest evidence base for trichotillomania and is considered first-line over pharmacotherapy. N-acetylcysteine (glutamate modulator) has some RCT evidence and is considered a pharmacological option, especially in adults, but is second-line. SSRIs alone have inconsistent evidence for trichotillomania; they are more effective in BDD and OCD. Low-dose antipsychotics are not indicated.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.