The Compulsive Hair-Pulling Disorder
31 October 2013
Trichotillomania is the compulsive urge to pull out, and in some cases eat (Trichophagia), ones hair leading to noticeable hair loss, distress, and social or functional impairment. The term comes from the Greek words trich (hair), till (pull) and mania (madness). Francois Henry Hallopeau, a French Dermatologist, coined this term in 1889 after encountering a young male patient who tore out every hair on his body in response to an intense itch. The Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association classified it as an impulse control disorder; stating that it is often chronic and very difficult to treat because many individuals with Trichotillomania may not realize they are pulling their hair. Patients presenting for diagnosis may either deny the criteria for tension prior to hair pulling or gain a sense of gratification after hair is pulled; therefore, Trichotillomania is subdivided into "automatic" versus "focused" hair pulling. “Automatic” pulling meaning the patient is not aware and unable to control themselves whereas “focused” pulling means the patient is knowingly pulling and getting a sort of satisfaction from the act.
Research indicates that about 1 in 50 people experience Trichotillomania in their lifetime, the typical onset being between ages 9 and 13, though it affects individuals of all ages.. When it occurs in early childhood, the condition is typically self-limiting and intervention is not required. While the most common hair pulling sites are the scalp, eyebrows, and eyelashes, Trichotillomania may involve any part of the body with hair. Less common locations for hair pulling include the pubic area, arms, chest, and legs; children are less likely to pull from anywhere except the head. An individual with Trichotillomania may use his or her fingernails, as well as tweezers, pins or other mechanical devices. Severe cases can result in permanent hair loss or skin damage. Trichotillomania frequently exists with other disorders according to several studies including a study performed by Christopher Flessner and his colleagues. It was found that up to sixty percent of individuals with Trichotillomania had another current psychiatric disorder. Disorders often comorbid with Trichotillomania include major depression, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, other impulse control disorders and substance abuse disorders. While some clinicians have speculated that the hair pulling may be a response to trauma, it has been stated that only five percent of patients have comorbid Trichotillomania and post-traumatic stress disorder. Hair pulling is a complex problem and has a great number of inputs, each of which can subsequently be influenced by a wide variety of factors. For some, there is often little or no awareness of their pulling. There are some who say that this automatic pulling may, at times, be closer to a tic of the type seen in Tourette's syndrome. Another group of patients report an extremely pleasurable or soothing feeling when pulling hair, as opposed to others who have the disorder and feel no joy or pleasure from it. The pulling itself is an immediately fascinating experience, and can function almost like a drug for some. Time can almost seem to stand still for them when they are engaged in this activity, and other problems temporarily vanish into the background. Others may go on to ritualize or play with the hair after they have pulled it out. There are also those whose pulling is done deliberately, which seems closer to classic Obsessive-Compulsive Disorder. Anxiety, depression and obsessive–compulsive disorder are more frequently encountered in people with Trichotillomania. This disorder has a high overlap with post traumatic stress disorder, and some cases, may be...
Please join StudyMode to read the full document