Childhood trichotillomania treated indirectly by punishing thumb sucking.

Trichotillomania was treated in a developmentally normal three-year-old by punishing thumb sucking. A behavioral analysis indicated a chain of behaviors that began with hair pulling and terminated in thumb sucking. The parents punished the thumb sucking by applying a bad tasting substance to the thumb. Both hair pulling and thumb sucking were rapidly eliminated. The child remained symptom free at 40 month follow-up. This study represents the third time trichotillomania has been treated in a preschooler indirectly by targeting finger sucking as the behavior to change. The significance of treating trichotillomania indirectly is discussed.