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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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Demystifying trichotillomania
From Nurse Practitioner, 2/1/02 by Whittaker, Heather

Alopecia from chronic hair pulling, called trichotillomania, occurs in children, adolescents, and adults. Trichotillomania can cause embarrassment and physical disfigurement, but many trichotillomania sufferers refuse to disclose that they pull their hair and avoid health care encounters. Behaviors such as hair twirling, hair examination, and eating or putting hair into the mouth are also associated with the condition.

Patients may pull different areas of body hair, which results in irregular hair loss from the scalp, eyebrows, eyelashes, and pubic area. Infection of the hair follicle can cause cellulitis or conjunctivitis with scarring and permanent hair loss. Patients who wear wigs or false eyelashes or whose eyebrows are penciled in may suffer from the condition.

Rule out the following conditions when considering a trichotillomania diagnosis: tinea capitus, endocrinopathies, lymphomas, atopic dermatitis, male pattern baldness, drug-induced alopecia, nutritional de ficiencies, or traction alopecia from hairstyling.

If you suspect trichotillomania, ask the patient about the hair loss. Patients willing to discuss their condition often describe heightened tension before hair pulling and pleasure or relief ofterward. Educating the patient about the condition helps reduce stigma.

Experts consider trichotillomania an impulse control disorder; therefore, you should determine if patients have comorbid conditions such as depression, anxiety, or obsessive-compulsive disorder. Treat patients with selective serotonin reuptake inhibitors and behavioral therapies or hypnosis. You may need to refer patients to a mental health professional specializing in trichotillomania. The Trichotillomania Learning Center, 831-457-1003 or http://www.trich.org can provide general and referral information.

Heather Whittaker, FNP, MSN

Karen Wolf, ANP, PhD

Nancy Keuthen, PhD

Boston, Mass.

Copyright Springhouse Corporation Feb 2002
Provided by ProQuest Information and Learning Company. All rights Reserved

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