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Trichotillomania (Impulse-Control Disorder)
This disorder is characterized by recurrent pulling out of
one's hair from the head, eyebrows, eyelashes or other body parts; causing
noticeable hair loss. High levels of tension build up before the act and a
sense of relief is experienced after the act. There is a certain degree of
obsessive-compulsive characteristics in this disorder.
- Recurrent pulling out of one's hair causing noticeable hair
loss
- Tension before the act
- Stress when attempting to control behavior
- Pleasure, gratification or relief after the act
Typically occurring
before adulthood, it has been demonstrated that between one to two percent
of college samples have this disorder or have had it in the past.
The primary feature of
this disorder is the recurrent pulling out of one’s own hair which
results in significant hair loss.
Behavior modification may
be the treatment of choice, with the possibility of exploring unconscious
issues related to the behavior.
Little
treatment data is available and studies show that the act of pulling out
one’s own hair can dissipate for months, and even years without any
psychological intervention.
What is Trichotillomania?
It is officially classified as an impulse control disorder,
along the lines of pyromania, kleptomania, and pathologic gambling.
What are the Symptoms of Trichotillomania?
- Recurrent pulling out of one’s hair resulting in
noticeable hair loss.
- An increasing sense of tension immediately before pulling
out the hair or when resisting the behavior.
- Pleasure, gratification, or relief when pulling out the
hair.
- The disturbance is not accounted for by another mental
disorder and is not due to a general medical condition (i.e., dermatological
condition).
- The disturbance causes significant distress or impairment
in social, occupational, or other important areas of functioning.
How
and When Does it Start?
People often start compulsive hair-pulling around the ages of
12-13; although it is not uncommon for it to start at a much younger or older
age. Frequently, a stressful event can be associated with the onset, such as:
change of schools, abuse, family conflict, or the death of a parent. The
symptoms also may be triggered by pubertal hormonal changes.
Does
Trichotillomania Lead To Other Problems?
During adolescence, which is an especially crucial time for
developing self-esteem, body image, comfort with sexuality, and relationships
with peers of both sexes, teens may endure ridicule from family, friends, or
classmates, in addition to feeling shame over their inability to control the
habit. Therefore, even a small bald patch can cause devastating problems with
development that can last life-long. Although many people with trichotillomania
get married and carry on with their lives in a normal fashion; there are those
who have avoided intimate relationships for fear of having their shameful secret
exposed.
What Is the
Cause?
There is no certain cause of trichotillomania, but the current
way of looking at trichotillomania is as a medical illness. One theory on a
biological level is that there is some disruption in the system involving one of
the chemical messengers between the nerve cells in parts of the brain. There may
be also a combination of factors such as a genetic predisposition and an
aggravating stress or circumstance; as with many other illnesses. Further,
trichotillomania could be a symptom caused by different factors in different
individuals just as a cough can be produced by a multitude of different medical
problems. Finding the cause(s) will take more research.
What
Is The Relation To Other Illnesses?
For many people with trichotillmania, there are symptoms of
obsessive-compulsive disorder (OCD) such as compulsive counting, checking, or
washing as well. There are so many similarities between hair pulling and other
compulsive symptoms that some consider it a subtype or variant of OCD. This idea
is supported by the tendency for the two problems to run in the same families
and the fact that OCD medications can be helpful in treating trichotillmania.
Depression also frequently occurs in individuals with this
illness. There may be a direct neuro-biochemical relationship and/or be
secondary to the chronic demoralization and low self esteem hair-pulling can
bring.
Other associated behaviors may include nail biting, thumb
sucking, head banging, or compulsive scratching. Frequently, hair pullers also
find they compulsively pick at their skin, which may also cause physical and
emotional scarring.
What
Treatments Are Available?
The two methods of treatment that have been scientifically
researched and found to be effective are behavioral therapy and medications.
Therapy:
In behavioral therapy, people learn a structured method of keeping track
of the symptoms and associated behaviors, increasing awareness of pulling,
substituting incompatible behaviors and several other techniques aimed at
reversing the "habit" of pulling.
Medications:
Although medications clearly help some people temporarily, symptoms are
likely to return when the medication is stopped unless behavioral therapy is
incorporated into treatment. Medications may help to reduce the depression and
any obsessive-compulsive symptoms the person may be experiencing
Commonly used medications are:
fluoxetine (Prozac)
luvoxamine (Luvox)
sertraline (Zoloft)
paroxetine (Paxil)
clomipramine (Anafranil)
valproate (Depakote)
lithium carbonate (Lithobid, Eskalith)
References
and Links
The
above information has been provided by:
Diagnostic and Statistical Manual of Mental Disorders. Vol. IV
American Psychiatric
Association. 1994
National Mental Health Association.. Information Fact
Sheets
http://www.nmha.org/
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