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Trichotillomania

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Trichotillomania
SpecialtyPsychiatry, psychology Edit this on Wikidata

Trichotillomania (TTM), or "trich" as it is commonly known, is an impulse control disorder 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. 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. Due to social implications the disorder is often unreported and it is difficult to accurately predict prevalence of trichotillomania; 2.5 million in the U.S. may have TTM, with a 1% prevalence rate.[1]

TTM seems to strike most frequently in the pre- or early adolescent years. The typical first-time hair puller is 12 years old, although TTM has affected people as young as one and as old as seventy. A form of TTM that affects very young children appears to occur in males and females at an equal rate and seems to be more benign in nature. [citation needed]

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


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, 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.[2]

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) because the sight or feel of a body part causes the individual anxiety, and physical disorders such as stereotypic movement disorder because the person performs repetitive movements without being bothered by or completely aware of them. 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.[3] One study showed that individuals with TTM have decreased cerebellar volume.[4] Anxiety, depression and OCD are more frequently encountered in people with TTM.[5] People with TTM may also eat/chew the roots of the hair that they pull, referred to as trichophagia. In extreme cases this can lead to Rapunzel syndrome, and even death.[6][7][8] Some individuals with TTM may feel they are the only person with this problem due to low rates of reportage.[9]

Treatment

Habit Reversal Training or HRT, has been shown to be a successful adjunct to medication as a way to treat TTM.[10] Many patients who pull their hair don’t realize that they are doing this; it is a conditioned response.[citation needed] 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 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.

Selective serotonin reuptake inhibitors are effective in the treatment of obsessive-compulsive disorder and are commonly used in the treatment of trichotillomania. Clomipramine treatment was shown to significantly improve symptoms when tested in a double-blind study.[11]

Fluoxetine and other similar drugs have limited usefulness in treating TTM, and can often have significant side effects.[12] According to F. Penzel, antidepressants can even increase the severity of the TTM.[3]

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 13 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.[13] Evidence now points to a genetic predisposition.[14][15]

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%[16] up to 5%[15] of the world's population.

Possible cause

Mario Capecchi, 2007 Nobel Prize winner, successfully injected genes that were suspected to cause trichotillomania to laboratory mice. The results showed that the mice obsessively pulled out their fur and the fur of other mice in the cage.[unreliable source?][17]

See also

References

Notes

  1. ^ 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.{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link)
  2. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ a b Penzel (2003) The Hair-Pulling Problem: A Complete Guide to Trichotillomania; Oxford University Press, p. 3. ISBN 0-19-514942-4
  4. ^ 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. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  5. ^ 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. {{cite journal}}: |access-date= requires |url= (help)
  6. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ^ 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.
  8. ^ "Hairball kills teenager". hairgrowthnews.com. Retrieved 2007-08-11.
  9. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ Christenson GA, Mackenzie TB, Mitchell JE, Callies AL. (1991). "A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania". Am J Psychiatry. 148 (11): 1566–71.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ^ "Entrez Gene: HOXB8 homeobox B8 [ Homo sapiens ]". National Center for Biotechnology Information. August 12 2006. Retrieved 2007-11-13. {{cite web}}: Check date values in: |date= (help)
  15. ^ a b "Hair pulling disorder gene found". BBC News. 29 September 2006. Retrieved 2007-05-01. {{cite web}}: Check date values in: |date= (help)
  16. ^ Christenson GA, Mackenzie TB, Mitchell JE (1991). "Characteristics of 60 adult chronic hair pullers". Am J Psychiatry. 148 (3): 365–70.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ^ de la Portilla, Diane (2008-04-15). "Nobel prize winner speaks at UTSA". The Paisano. Retrieved 2008-05-13. {{cite news}}: Cite has empty unknown parameter: |1= (help)

Bibliography

  • 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


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