Do some patients just naturally recover from trichotillomania without medications or treatment? — Donovan Hair Clinic
Trichotillomania “Natural Recovery” May Occur in One Quarter of Patients
Trichotillomania is often viewed as a chronic lifelong condition. There has been some thought among experts that the condition may resolve spontaneously and completely in some patients even without treatment. For example, this phenomenon of “natural recovery” is well known in young children 3-6 years of age. In this age group, periods of hair pulling can be followed by complete resolution of the condition and no further pulling for the life of the patient.
Despite the intensive research in TTM, there has been little attention overall on the natural resolution or natural recovery of the condition.
What is TTM natural recovery?
Natural recovery means the patient once had TTM and subsequently no longer has TTM after long period of monitoring.
Natural recovery means that
a) the patient once did meet diagnostic criteria for the disorder in the past
b) the patient subsequently did not meet any diagnostic criteria for the disorder for a period of at least 12 months
c) the patient has gone about attaining this achievement without any formal psychological or pharmacological interventions
Grant et al, 2022
In a new study, authors screened a sample of 10,169 adults, aged 18–69 years felt to be representative of the general US population. Participants were screened for current and lifetime trichotillomania.
In total, 24.9% of the entire sample of people with lifetime trichotillomania reported that they no longer had symptoms of trichotillomania and had never received therapy or medication treatment for it (i.e. they experienced what is being termed a natural recovery).
Interestingly, those who experienced natural recovery did not differ from those with current trichotillomania in terms of demographic or clinical characteristics, except that they were currently older. Natural recovery was associated with significantly lower rates of related comorbidities: obsessive-compulsive disorder, attention-deficit hyperactivity disorder, panic disorder, skin picking disorder and tic disorder. One of the strongest predictors of natural recovery, of the variables examined, was the lack of: obsessive-compulsive disorder comorbidity
This was an interesting study. Dr Grant is one of the key experts in trichotillomania research. In this paper, he reminds us that natural recovery (recovery without treatment) has been known to occur in other mental health conditions. For example, in the area of obsessive-compulsive disorder (OCD), the authors point out that rates of remission (i.e. a type of natural recovery) range from 20% to 24% (Pollitt, 1957; Skoog and Skoog, 1999)
In the case of major depressive disorder, the authors point out that a recent meta-analysis found a pooled estimate of 12.5% of people with untreated depression achieved remission within 12 weeks (Mekonen et al., 2021).
Overall, the finding that roughly one-fourth of adults with a history of trichotillomania recover from their problems suggests that trichotillomania does not always follow a chronic or persisting course, and that different individuals experience a very different course.
Grant JE and Chamberlain SR.Natural recovery in trichotillomania. Aust N Z J Psychiatry. 2022 Oct;56(10):1357-1362.
Mekonen T, Ford S, Chan GCK, et al. (2021) What is the short-term remission rate for people with untreated depression? A systematic review and meta-analysis. Journal of Affective Disorders 296: 17–25.
Pollitt J (1957) Natural history of obsessional states; a study of 150 cases. British Medical Journal 1: 194–198.
Skoog G and Skoog I (1999) A 40-year follow-up of patients with obsessive-compulsive disorder [see comments]. Archives of General Psychiatry 56: 121–127.