Trichotillomania Health Article

Definition

Individuals with trichotillomania repetitively pull out their own hair. Trichotillomania as an impulse-control disorder. Some researchers view it as a type of affective or obsessive-compulsive disorder. Nail-biting, skin-picking, and thumb-sucking are considered to be related conditions.

Description

Trichotillomania involves hair-pulling episodes that result in noticeable hair loss. Although any area of the body can be a target, the most common areas are the scalp, followed by the eyelashes, eyebrows, and pubic region. Hair-pulling can occur without the individual's awareness, but is frequently preceded by a sense of increasing tension and followed by a sense of relief or gratification. The resulting hair loss can be a source of embarrassment or shame. Because of a tendency to hide symptoms, and because professionals are relatively unfamiliar with the disorder, individuals either may not seek, or are offered treatment. Untreated trichotillomania can result in impaired social functioning and medical complications.

Causes

Scientific research regarding trichotillomania has been conducted primarily in the past 10 years and causes are only theoretical. Psychoanalytic theories suggest that the behavior is a way of dealing with unconscious conflicts or childhood trauma (such as sexual abuse). Biological theories look for a genetic basis. For instance, people with trichotillomania often have a first-degree relative with an obsessive-compulsive spectrum disorder. Researchers are also evaluating similarities between trichotillomania and Tourette's disorder. Behavioral theories assume that symptoms are learned, that a child may imitate a parent who engages in hair-pulling. The behavior may also be learned independently if it serves a purpose. For example, hair-pulling may begin as a response to stressand then develop into a habit.

Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR), produced by the American Psychiatric Association and used by most mental health professionals in North America and Europe to diagnose mental disorders, the following conditions must be present for a diagnosisof trichotillomania:

• noticeable hair loss (alopecia) due to recurrent hair-pulling
• tension immediately before hair-pulling, or when attempting to resist hair-pulling
• reduction of tension, or a feeling of pleasure or gratification, immediately following hair-pulling
• significant distress or impairment in social, occupational, or other important areas of functioning

In addition, the DSM-IV-TRrequires that hair-pulling not be due to another medical or mental disorder. The tension-release requirement is controversial because 17% of people who otherwise qualify for this diagnosis do not experience this.

Symptoms usually emerge in early adolescence. Episodes may last a few minutes or a few hours during periods of stress or relaxation. Hairs with unique textures or qualities may be preferred. The pulling may include rituals, such as twirling hair off or examining the root. Half of those individuals with trichotillomania engage in oral behaviors—running hair across the lips or through the teeth, biting off the root (trichophagy), or eating hair (trichophagia). The usually try to control their behavior in the presence of others and may hide the affected areas. Symptoms may come and go for weeks, months, or years at a time.