Trichotillomania

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Not to be confused with Trichomoniasis.
Trichotillomania
Classification and external resources
ICD-10 F63.3
ICD-9 312.39
DiseasesDB 29681
MedlinePlus 001517
eMedicine derm/433  ped/2298

Trichotillomania (Mekonosis/Mekonicity - medical terms given due to the resemblance of those with TTM to the villianous alien in the Dan Dare comic series) (also known as "Trichotillosis"[1]), or "trich" as it is commonly known, is an impulse control disorder or form of self-injury characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches.[2]:645 Trichotillomania is classified in the DSM-IV as an impulse control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual's teenage years. Depression or stress can trigger the trich. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence of trichotillomania; 2.5 million in the U.S. may have TTM, with a 1% prevalence rate.[3]

The name derives from Greek: tricho- (hair), till(en) (to pull), and mania.

Contents

[edit] Characteristics

Individuals with trichotillomania live relatively normal lives; however, they may have bald spots on their head, among their eyelashes, pubic hair, or brows. An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs, wear false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms (known as 'pulling') whatsoever. This 'pulling' often resumes upon leaving this environment.[4]

Many clinicians classify TTM as a habit behavior, in the same family as nail biting (onychophagia) or compulsive skin picking (dermatillomania). These disorders are a cross between mental disorders, such as obsessive compulsive disorder (OCD), and physical disorders such as stereotypic movement disorder because the person performs repetitive movements without being bothered by or completely aware of them. Some say that pimples on the scalp is all it takes to trigger the pulling in some of those who suffer from TTM. Supposedly, areas that are sore intensify the feeling of pulling. The more the area becomes agitated by pulling, the feeling intensifies, only causing the puller to become obsessed with pulling more. It is also widely believed that individuals with TTM pull because of the sight or feel of a certain area of hair. This theory varies by the individual, as some TTM sufferers say the disorder is not an obsession with looks but rather a habit or an addiction. The current classification of trich as an impulse disorder with pyromania, pathological gambling and kleptomania, has been called into question as inadequate and in need of revision.[5] One study showed that individuals with TTM have decreased cerebellar volume.[6] Anxiety, depression and OCD are more frequently encountered in people with TTM.[7] People with TTM may also eat/chew the hair that they pull, referred to as trichophagia. In extreme cases this can lead to Rapunzel syndrome, and even death.[8][9][10] Some individuals with TTM may feel they are the only person with this problem due to low rates of reporting.[11]

[edit] Treatment

Habit Reversal Training or HRT, has been shown to be a successful adjunct to medication as a way to treat TTM.[12] With Habit Reversal Training, doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. As a part of the behavioral record-keeping component of HRT, patients are often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well as what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes.

Treatment with clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to significantly improve symptoms.[13]

Fluoxetine (Prozac) and other similar SSRI drugs have limited usefulness in treating TTM, and can often have significant side effects.[14] According to F. Penzel, antidepressants can even increase the severity of the TTM.[5]

A recent study has shown positive results using a treatment of acetylcysteine[15].

Hypnotherapy has been used to treat it with some success by addressing the symptoms using hypnosis.

[edit] Epidemiology

TTM is diagnosed in all age groups; it is more common during the first two decades of life, with mean age of onset usually reported between 9 and 14 years of age. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female.[16] Evidence now points to a genetic predisposition.[17][18]

The number of reported trichotillomania cases has increased throughout the years, possibly due to a reduced stigma associated with the condition. Estimates of the number of persons with TTM range from 1–3%[19] up to 5%[18] of the world's population.

[edit] See also

[edit] Notes

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0721629210.
  2. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
  3. ^ Diefenbach, G.J., Reitman, D. & Williamson, D.A., (2000). "Trichotillomania: A challenge to research and practice". Clinical Psychology Review 20 (20): 289–309. doi:10.1016/S0272-7358(98)00083-X. 
  4. ^ Christenson GA, Mackenzie TB, Mitchell JE (1991). "Characteristics of 60 adult chronic hair pullers". The American journal of psychiatry 148 (3): 365–70. PMID 1992841. 
  5. ^ a b Penzel (2003) The Hair-Pulling Problem: A Complete Guide to Trichotillomania; Oxford University Press, p. 3. ISBN 0-19-514942-4
  6. ^ Keuthen NJ, Makris N, Schlerf JE, et al. (2007). "Evidence for reduced cerebellar volumes in trichotillomania". Biol. Psychiatry 61 (3): 374–81. doi:10.1016/j.biopsych.2006.06.013. PMID 16945351. 
  7. ^ Christenson GA, Crow SJ (1996). "The characterization and treatment of trichotillomania". The Journal of clinical psychiatry 57 Suppl 8: 42–7; discussion 48–9. PMID 8698680. 
  8. ^ Ventura DE, Herbella FA, Schettini ST, Delmonte C (2005). "Rapunzel syndrome with a fatal outcome in a neglected child". J. Pediatr. Surg. 40 (10): 1665–7. doi:10.1016/j.jpedsurg.2005.06.038. PMID 16227005. 
  9. ^ Pul N, Pul M (1996). "The Rapunzel syndrome (trichobezoar) causing gastric perforation in a child: a case report". Eur. J. Pediatr. 155 (1): 18–9. PMID 8750804. 
  10. ^ "Hairball kills teenager". hairgrowthnews.com. http://www.keratin.com/ar/ar012.shtml. Retrieved on 2007-08-11. 
  11. ^ Christenson GA, MacKenzie TB, Mitchell JE (1994). "Adult men and women with trichotillomania. A comparison of male and female characteristics". Psychosomatics 35 (2): 142–9. PMID 8171173. 
  12. ^ Woods DW, Wetterneck CT, Flessner CA (2006). "A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania". Behaviour research and therapy 44 (5): 639–56. doi:10.1016/j.brat.2005.05.006. PMID 16039603. 
  13. ^ Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL (1989). "A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling)". N. Engl. J. Med. 321 (8): 497–501. PMID 2761586. 
  14. ^ Christenson GA, Mackenzie TB, Mitchell JE, Callies AL (November 1991). "A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania". Am J Psychiatry 148 (11): 1566–71. PMID 1928474. http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=1928474. 
  15. ^ Grant J, et al (2009). "N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania". Archives of General Psychiatry 66: 756-63. 
  16. ^ Sah DE, Koo J, Price VH (2008). "Trichotillomania". Dermatol Ther 21 (1): 13–21. doi:10.1111/j.1529-8019.2008.00165.x. PMID 18318881. 
  17. ^ "Entrez Gene: HOXB8 homeobox B8 [ Homo sapiens ]". National Center for Biotechnology Information. August 12, 2006. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=gene&cmd=Retrieve&dopt=Graphics&list_uids=3218. Retrieved on 2007-11-13. 
  18. ^ a b "Hair pulling disorder gene found". BBC News. 29 September 2006. http://news.bbc.co.uk/1/hi/health/5381232.stm. Retrieved on 2007-05-01. 
  19. ^ Christenson GA, Mackenzie TB, Mitchell JE (1991). "Characteristics of 60 adult chronic hair pullers". Am J Psychiatry. 148 (3): 365–70. 

[edit] Further reading

  • Keuthen, Stein, Christensen & Christenson (2001) Help for Hair Pullers: Understanding and Coping With Trichotillomania; New Harbinger Publications, ISBN 1-57224-232-9
  • Parker (Ed.) (2004) Trichotillomania - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References ; Icon Health Publications, ISBN 0-597-84664-2
  • Stein (Ed.), Christenson (Ed.) & Hollander (Ed.) (1999) Trichotillomania; American Psychiatric Press, ISBN 0-88048-759-3

[edit] External links


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