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Trichotillomania

Trichotillomania (TTM) is an impulse control disorder characterised by the repeated urge to pull out scalp hair, eyelashes, nose hair, ear hair, eyebrows or other body hair. It is believed to be related to obsessive-compulsive disorder. more...

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Most TTM sufferers live relatively normal lives, except for having bald spots on their head. Many clinicians classify TTM as a mental disorder, though the classification is debatable. Some clinicians classify TTM as a form of obsessive-compulsive disorder. Some classify TTM as a form of self-harm. Others say that TTM is no more a mental disorder than is any other habitual behavior, such as nail biting. Many TTM sufferers have relatively normal work and social lives; and TTM sufferers are not any more likely to have significant personality disorders than anyone else.

There have been recent clinical trials of drug treatment for trichotillomania, for example using anafranil, prozac, and lithium. One should use care in choosing a therapist who has specific 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.

A practice related to TTM is trichophagia, in which hairs are sucked and/or eaten. In extreme cases, this can lead to the development of a hairball (trichobezoar) in the abdomen, a serious condition in humans; see Rapunzel syndrome.

Treatment for Trichotillomania

Trichotillomania is classified as an Obsessive Compulsive Spectrum Disorder. Compulsive Spectrum Disorders are obsessive compulsive qualities that are related and similar to that of Obsessive Compulsive Disorder.

Habit Reversal Training

One form of treatment for Trichotillomania is Habit Reversal Training. Many patients who pull their hair don’t realize that they are doing this; it is a conditioned response. With Habit Reversal Training doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. Patients who feel the urge to pick at their hair are taught to visualize something that will get their mindset off of picking at their hair. Once they are aware of what they are doing then they are able to focus and stop themselves from the urge of picking.

Patients are also 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.

Medications

Selective seretonin 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.

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Racial identity may affect impact of trichotillomania on black women: pulling hair from scalp, pubic region - Clinical Rounds
From OB/GYN News, 12/1/03 by Betsy Bates

CHICAGO -- Trichotillomania among African American women often involves pulling of the pubic hair as well as pulling of hair from the scalp, eyelashes, or eyebrows, which may add to the profound sense of shame patients feel, Angela Neal-Barnett, Ph.D., reported.

The compulsive pulling out of hair is a poorly understood phenomenon, with debate still raging over whether it is an anxiety disorder or a habit disorder. A review of the literature shows a dearth of good epidemiologic studies describing the disorder in any population, she said at an international symposium sponsored by L'Oreal Institute for Ethnic Hair and Skin Research.

Dr. Neal-Barnett does not know whether trichotillomania is more common in African Americans than in other ethnic groups, she said in an interview, "but I do believe it is more hidden."

The pulling of pubic hair had been noted in previous studies, but in Dr. Neal-Barnett's extensive interviews and psychological testing of 41 African American women from the United States, France, the Netherlands, and South Africa, it became clear that the pulling of hair from more than one body site is a common experience among this group.

The third most frequent body site for pulling hair was the pubic region, behind the scalp and eyelashes, said Dr. Neal-Barnett, a psychologist from Kent (Ohio) State University.

Fourteen subjects pulled hair from the eyelashes and pubic area, 11 from the scalp and pubic area, and 5 from the eyebrows and pubic area. Several women pulled hair from their underarms, arms, and/or legs.

Women who acknowledged trichotillomania were significantly more likely to have negative emotions, to have first-degree relatives who were cosmetologists, to have a history of abuse, and to have received negative messages about hair as children.

Importantly, a strongly significant negative correlation was round between the subjects' ratings of how much hair-pulling interfered with their lives and the racial identity dimension of private regard.

Robert Sellers, Ph.D., described four dimensions of racial identity, including private regard, described as "the extent to which individuals feel positively or negatively toward African Americans as well as how positively or negatively they feel about being African American," she said.

In Dr. Neal-Barnett's study, women who had high private regard described the impact of trichotillomania on their lives as minimal, and vice versa. "I really, really want to stress that this does not mean a woman hates being black so she pulls out her hair," Dr. Neal-Barnett said at the meeting, also sponsored by Howard University.

Anxiety disorders may lead to cognitive distortion, offering a potential insight into the findings, she noted.

The profound level of embarrassment expressed by women in the study suggests that patients suffering from the disorder may hide the problem from physicians, psychologists, and cosmetologists.

COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2003 Gale Group

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