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Trichotillomania and grooming disorders A spectral relation between OCD and trichotillomania (TTM) is described, and there is reported efficacy of SRIs in TTM, as with OCD.63 However, the response to treatment with SRIs in individuals with TTM is inconsistent.64 Comparisons between TTM and addictive disorders have also been made, given that impulsivity and dysfunctional reward pathways may be operative in both types of disorder, and there has been some benefit in treating TTM with opioid antagonists.65 Trichotillomania may have a heterogeneous nature, with one subgroup more similar to OCD and another subgroup more similar to addiction.66 Two case studies suggested benefits of NAC treatment in individuals with TTM.39 The first involved a 28-year-old man and the second a 40-year-old woman