Hair pulling disorder (i.e., trichotillomania, TTM) and skin picking disorder (SPD) are
often categorized under the umbrella term of BFRB disorders. These repetitive,
intentionally performed behaviors often cause noticeable cosmetic issues and may result
in clinically significant distress or functional impairment.
Behavioral therapy (BT) is generally regarded as the first-line treatment for BFRBs. One
type of BT is comprehensive behavioral treatment (ComB), a treatment that emphasizes
habit reversal training and various techniques that target specific BFRB triggers (e.g.,
sensory cues, such as pressure on the scalp; environmental cues, such as bright lights
and mirrors), including emotion dysregulation. The ComB protocol was methodically
developed based on expert consensus and demonstrated promising results in one single case
design study and a randomized controlled trial comparing it to a minimal attention
control condition.
Research has also found benefit of pharmacological agents in the treatment of BFRBs. Most
recently, a randomized controlled trial of memantine vs. placebo found statistically
significant improvements in disorder severity and life functioning in the memantine group
as compared to the placebo group.
Although there are emerging behavioral and psychopharmacological interventions for BFRBs,
the research is limited. Additionally, there are no studies comparing the efficacy of
first-line behavioral treatments to promising medication interventions for this class of
disorders. Given the serious personal consequences associated with trichotillomania and
skin picking disorder, there is substantial need for additional research to clarify the
best available treatments for BFRBs. Doing so would facilitate future research and the
development of refined treatment guidelines. Therefore, the current trial aims to compare
the efficacy of behavioral therapy and memantine in adults with trichotillomania and skin
picking disorder.
