The onset or exacerbation of trichotillomania (TT) within 6 months of starting treatment with methylphenidate (dose unreported) for ADHD is reported in 3 boys, aged 7 to 12 years, followed at the Yale Child Study Center, New Haven, CT. All three reported subjective tension relieved after hair-pulling from the scalp, and one also pulled and ate his eyebrows and eyelashes. Symptoms abated slowly or diminished in two, despite continuation of MPH; TT persisted in one after switching to imipramine. In a clinic for TT, affected boys had greater withdrawal and social problems than girls. Boys were more likely to suffer from ADHD and to be exposed to stimulant therapy. [1]

COMMENT. Tics and compulsive behaviors are well known complications of stimulant therapy for ADHD. Trichotillomania, a further side-effect of MPH to be aware of, has been seen occasionally in our own clinic for ADHD where relatively low doses of MPH are usually prescribed.

Retrospective review of treatment outcome for 63 patients with trichotillomania is reported from the Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA 02129 [2]. Mean age at onset was 12 years and age at follow up was 33 years. The patients (92% female, 8% male) had been treated for 6 years: 57 (90%) received behavioral treatment, 46 (73%) medication, and 41 (65%) both medication and behavioral therapy. Various medications were prescribed, including clomipramine (59%), fluoxetine (50%), and lithium (15%). At follow-up, 32 (51%) were still receiving some therapy, and 27 (49%) were untreated. Total Hairpulling Scale scores showed significant improvements in 52%, and no response in 48%. Improvements had also occurred in measurements of self-esteem, psychosocial functioning, depression and anxiety. Responders had higher baseline depression scores than nonresponders, but a cause and effect correlation was undetermined. None of these subjects had ADHD and none received stimulant therapy.