We recommend psychotherapy, specifically habit reversal therapy (HRT), if available (see below) rather than pharmacotherapy as first-line treatment for Trichotillomania, except for adults with moderate-severe illness for whom medication plus therapy is indicated. Adjunctive pharmacotherapy should be considered on a case-by-case basis.

initiation/ongoing treatment

Baseline investigations are generally unnecessary for NAC, in the absence of systemic disease.

For clomipramine, it is best practice to undertake a baseline EKG (ECG). Baseline investigations prior to initiation of antipsychotic medication should include an EKG (ECG), fasting lipid levels and glucose, liver function tests, urea and electrolytes, full blood count, and prolactin; pulse and blood pressure should be recorded along with body mass index and waist circumference. These should be repeated at 6 months, then at 1 year, then annually thereafter (unless there are specific concerns).

Before starting psychotherapy, the clinician should make sure the patient (and family, in the case of children) knows the intended number of therapy sessions, and the need to perform homework assignments.

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