Elimination of thumb-sucking as a treatment for severe trichotillomania.

A 5-year-old girl presented with a 3-year history of severe trichotillomania and alopecia. The trichotillomania was observed to covary, or occur only in the presence of thumb-sucking. Thus, the elimination of thumb-sucking was targeted as a treatment for trichotillomania. The investigation evaluated the relative effectiveness of a standard aversive taste treatment, a response-dependent alarm and a response-disrupting thumb-post. Results indicated that only the thumb-post completely eliminated thumb-sucking and the covarying trichotillomania. These results suggest that when trichotillomania is a benign habit disorder, the treatment of a covarying habit such as thumb-sucking can be an effective treatment alternative and that resilient thumb-sucking can be effectively managed with an easily implemented thumb-post that requires little supervision and provides long-term success.