Trichotillomania

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Trichotillomania
Classification & external resources

ICD-10	F63.3
ICD-9	312.39

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, beard hair, nose hair, pubic hair, eyebrows or other body hair. It may be distantly related to obsessive-compulsive disorder, with which it shares some similarities. The number of reported trichotillomania sufferers has increased throughout the years, possibly due to a reduced stigmatism around the condition. The number of reported sufferers is currently estimated to be 1% or 2% of the population. People with trich have been known to refer to themselves as "trichsters".

Contents 1 History 2 National Trichotillomania Awareness Week 3 Treatment for Trichotillomania 3.1 Habit Reversal Training 3.2 Medications 3.3 Stimulus Control Techniques 4 References 5 See also 6 Books 7 External links

[edit] History

Trichotillomania has been mentioned as a disorder in very early historical records.^{[citation needed]}For many there seems to be a strong stress-related component, that is, in low-stress environments some sufferers exhibit no symptoms, known as 'pulling', whatsoever. This 'pulling' often resumes upon leaving this environment.^{[citation needed]}

65% of those afflicted are female ^[1]

Evidence now points to a genetic predisposition ^[2]

Most TTM sufferers live relatively normal lives, except for having bald spots on their head, among their eyelashes, pubic hair, or brows. Eyelashes have been reported to grow back thinner or in much lesser amounts.^{[citation needed]}

An additional danger is from the low self-esteem associated with being shunned by peers, and the fear of socializing due to appearance.

Many clinicians classify TTM as a habitual behavior, in the same family as nail biting (onychophagia) or compulsive skin picking (dermatotillomania). These disorders are a cross between mental disorders, such as OCD obsessive compulsive disorder because the sight or feel of a body part causes the sufferer anxiety, and physical disorders such as Stereotypic Movement Disorder because the sufferer performs repetitive movements without being bothered by or completely aware of them. Many TTM sufferers have normal work and social lives; and TTM sufferers are not any more likely to have significant personality disorders than anyone else.^{[citation needed]}

While there is no cure, there are some treatments. There have been a few small and not well-controlled clinical trials of drug treatment for trichotillomania, for example using such drugs as anafranil, prozac, and lithium. There have also been anecdotal reports of vitamin therapy being successful.^{[citation needed]} No one medication has been shown to have a particular advantage over any other, and drugs alone have not been shown to be particularly effective for many people. One should use care in choosing a therapist who has specific training, experience, and insight into the condition, lest one be overdiagnosed or overmedicated. Prozac and other similar drugs, which some professionals prescribe on a one-size-fits-all basis, tend to have limited usefulness in treating TTM, and can often have significant side effects.^{[citation needed]}

Patients should be cautioned that treatment of comorbid conditions such as Attention Deficit Hyperactivity Disorder with stimulants may increase the frequency and intensity of hair-pulling.^[3]

A practice related to TTM is trichophagia, in which hairs are swallowed. In extreme cases, this can lead to the development of a hairball (trichobezoar) in the abdomen, a serious condition in humans; see Rapunzel syndrome. A trichobezoar can lead to intestinal blockage, which may only be relieved via surgery. ^[4]

[edit] National Trichotillomania Awareness Week

The Trichotillomania Learning Center (TLC) was founded in 1991 by a sufferer and is a national nonprofit organization, providing information, referrals, national conferences and retreats. For more information on the history and services of TLC, please visit their website www.trich.org.

[edit] Treatment for Trichotillomania

Trichotillomania is unofficially classified by some as an Obsessive Compulsive Spectrum Disorder, although there is some question as to whether such a spectrum actually exists at all.^{[citation needed]}

[edit] Habit Reversal Training

As of the present time, other than medication, the only treatment shown to have any documented effect on the symptoms of "trich" is a behavioral treatment known as Habit Reversal Training or HRT.^{[citation needed]} This was developed by Dr. Nathan Azrin and colleagues and first published in 1973 in an article titled Habit Reversal: A Method of Eliminating Nervous Habits and Tics. The treatment focused on getting patients to increase their awareness of their behavior by recording and learning as much as possible about when, where, and how it occurred, and how to know ahead of time when it would occur. They were next trained to focus on, and reduce the tension that preceded the pulling. Finally, they were taught to perform a muscular movement that was inconspicuous, that was the opposite of, and incompatible with the behavior they wished to eliminate, and which would become an overlearned behavior. 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.

Trichotillomania is a chronic problem, meaning that although one can recover from it, there is currently no cure. It can be a stubborn problem, but with proper treatment and persistence, picking and or pulling hairs can be greatly reduced and even brought under control. Clinicians who are specialized in treating this problem are not always easy to find, but do have the techniques and training to bring about substantial improvement.

[edit] Medications

Selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of trichotillomania. Antidepressants have been shown to be effective in treating both Obsessive-Compulsive Disorder and trichotillomania.

Antidepressants are only one of many treatments being tried at this time, along with reverse behavior treatment, attepmting to "unlearn" the behavior or habit. The most promising news is Aug-Sept 2006 sciencetitsts have discovered a gene that seems to be present in many people with this condition. More study is needed and underway.

[edit] Stimulus Control Techniques

Stimulus Control is a well-known behavioral treatment that in the case of trichotillomania, seeks to help sufferers first identify, and then eliminate, avoid, or change the particular activities, environmental factors, states, or circumstances that trigger hair pulling. The goal is to consciously control these triggers (or stimuli or cues as they are also known) that lead to pulling, and to create new learned connections between the urge to pull, and new non-destructive behaviors. It is often combined with Habit Reversal Training, and utilizes the self-recorded information that is a part of that treatment.

[edit] References

1. ^ 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. 
2. ^ EntrezGene (12-Aug-2006). Gene (UTF-8). National Center for Biotechnology Information.
3. ^ "Tricotillomania and its Treatment in Children and Adolescents: A Guide for Clinicians", Trichotillomania Learning Center, Retrieved 8 March 2007
4. ^ Hairball kills teenager.

[edit] See also

• Dermatillomania
• Onychophagia

[edit] Books

• Penzel (2003) The Hair-Pulling Problem: A Complete Guide to Trichotillomania; Oxford University Press, ISBN 0-19-514942-4
• Keuthen, Stein, Christensen & Christenson (2001) Help for Hair Pullers: Understanding and Coping With Trichotillomania; New Harbinger Publications, ISBN 1-57224-232-9
• Stein (Ed.), Christenson (Ed.) & Hollander (Ed.) (1999) Trichotillomania; American Psychiatric Press, ISBN 0-88048-759-3
• Parker (Ed.) (2004) Trichotillomania - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References ; Icon Health Publications, ISBN 0-597-84664-2

[edit] External links

• Trichotillomania at OCD Center of Los Angeles
• Psychiatric Times article
• MSNBC story Gene found at the root of hair-pulling disorder
• University of Minnesota Impulse Control Disorders Clinic — Provides useful information and resources for patients and their families, including free questionnaire-based rating scales that patients can use to assess and track the severity of their condition.