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Emotion regulation, distress tolerance, and experiential avoidance in adults with Trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder.

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Placebo response in trichotillomania.

Jon E Grant1, Samuel R Chamberlain, Sarah A Redden

  • 1aDepartment of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, Illinois bDepartment of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts cDepartment of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA dSchool of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen eH. Lundbeck A/S, Copenhagen fDepartment of Psychiatry, University of Cambridge gCambridge and Peterborough NHS Foundation Trust, Cambridge, UK hDepartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.

International Clinical Psychopharmacology
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Summary

Predicting treatment response in trichotillomania is challenging. This study found no baseline characteristics differentiate placebo responders from non-responders in clinical trials for this hair-pulling disorder.

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Area of Science:

  • Psychiatry and Behavioral Sciences
  • Clinical Psychology
  • Pharmacology

Background:

  • Trichotillomania is a significant mental health condition lacking FDA-approved medications.
  • High placebo response rates complicate the assessment of pharmacologic treatments for trichotillomania.
  • Understanding predictors of placebo response is crucial for designing effective clinical trials.

Purpose of the Study:

  • To investigate baseline demographic and clinical characteristics that predict placebo response in trichotillomania.
  • To identify factors influencing treatment outcomes in placebo-controlled trials for hair-pulling disorder.

Main Methods:

  • Pooled data from 104 participants receiving placebo across five double-blind trials.
  • Participants classified as responders (≥35% reduction on Massachusetts General Hospital Hair Pulling Scale) or non-responders.
  • Statistical comparison of demographic and clinical variables between placebo responder and non-responder groups.

Main Results:

  • 31% of participants in the placebo group demonstrated a significant clinical response.
  • No significant differences in demographic or clinical variables were found between placebo responders and non-responders.
  • Predictors of placebo response in trichotillomania remain unidentified and differ from other mental health disorders.

Conclusions:

  • Baseline characteristics do not reliably predict placebo response in trichotillomania.
  • The factors driving placebo effects in trichotillomania require further investigation.
  • This finding has implications for the design and interpretation of future clinical trials for hair-pulling disorder.