Tatalaksana Komprehensif Trikotilomania

Abstract

Trichotillomania is a psychiatric disorder characterized by recurrent and irresistible urges to pull out one’s own hair. It is classified as a habit and impulse control disorder in ICD-10 and as part of the Obsessive-Compulsive and Related Disorders group in DSM-5. Epidemiologically, this condition affects approximately 1.14% to 3% of the global population, with a higher prevalence among adult females, and is often accompanied by comorbidities such as anxiety disorders or depression. The etiology is multifactorial, involving a complex interaction between genetic vulnerability, abnormalities in brain structure and metabolism, and maladaptive coping mechanisms to stress. The main clinical manifestation is noticeable hair loss resulting from repetitive hair-pulling behavior, typically preceded by emotional tension and followed by a temporary sense of relief. Comprehensive management involves a multimodal approach, in which behavioral therapy—particularly Cognitive Behavioral Therapy (CBT) with Habit Reversal Training (HRT)—is considered the first-line treatment, while pharmacotherapy such as clomipramine or selective serotonin reuptake inhibitors (SSRIs) may be considered in moderate to severe cases. Prognosis varies depending on the age of onset and treatment success; however, early detection and management of comorbidities are crucial to prevent long-term psychosocial consequences and to improve patients’ quality of life.