Trichotillomania Disorder in a Child with Intellectual Disability and the Efficacy of Habit-Reversal Training Techniques: A Case Report

Trichotillomania disorder, or hair pulling disorder, is a condition in which patients unconsciously engage in hair-pulling, which reinforces compulsive hair pulling behaviors, culminating in conscious and deliberate hair pulling. Behavioral therapy is a common treatment approach for this disorder. Habit-reversal training (HRT) is a particularly effective treatment method for children with intellectual disabilities who exhibit this disorder. This case report presents the efficacy of HRT in reducing trichotillomania-associated severity and distress. The patient was a 13-year-old girl with intellectual disability who met the diagnostic criteria for trichotillomania according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). She received eight sessions of HRT techniques over one month. The Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) was employed to measure the severity and distress of the hair pulling behavior. Given the patient’s intellectual disability (intelligence quotient [IQ]=65) and limited ability to respond to self-report questions about the nature of self-interests, the parent-report version of the scale was used both during the treatment and the one-month follow-up. The effectiveness of the intervention was evaluated using visual analysis of graphs, percentage of improvement, effect size, and photographs of the eyebrow hair pulling before and after treatment. The results indicated that the HRT significantly reduced both the severity (effect size=1.75) and distress (effect size=1.77) of the trichotillomania disorder, and the patient exhibited a high percentage of improvement. The one-month follow-up demonstrated that the results were maintained.