Trichotillomania

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Trichotillomania Classification and external resources
ICD-10	F63.3
ICD-9	312.39
DiseasesDB	29681
MedlinePlus	001517
eMedicine	derm/433  ped/2298

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 predict accurately 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.

Contents 1 Characteristics 2 Treatment 3 Epidemiology 4 Possible cause 5 See also 6 References 6.1 Notes 6.2 Bibliography 7 External links

[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, 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]

[edit] 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]

[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 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.

[edit] 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]}

[edit] See also

• Dermatillomania
• Onychophagia
• Dermatophagia

[edit] References

[edit] Notes

[edit] 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

[edit] External links

• Trichotillomania at the Open Directory Project
• Trichotillomania Learning Center
• Psychiatric Times article

v • d • e WHO ICD-10 mental and behavioral disorders (F · 290–319) Neurological/symptomatic Dementia (Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia) · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol (drunkenness, alcohol dependence, delirium tremens, Korsakoff's syndrome, alcohol abuse) · opioids (opioid dependency) · sedative/hypnotic (benzodiazepine withdrawal) · cocaine (cocaine dependence) · general (Intoxication, Drug abuse, Physical dependence, Withdrawal) Psychotic disorder Schizophrenia (disorganized schizophrenia)  · Schizophreniform disorder  · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood (affective) Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder (Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia) · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder (Ganser syndrome) · Somatoform disorder (Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia)  · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia (Hypersomnia, Insomnia) · Parasomnia (REM behavior disorder, Night terror) · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postnatal depression Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development (developmental disorder) Specific: speech and language (expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp) · Scholastic skills (dyslexia, dysgraphia, Gerstmann syndrome) · Motor function (developmental dyspraxia) Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech (stuttering · cluttering)