Trichotillomania is an obsessive–compulsive related disorder characterized by irresistible urges to pull out hair, resulting in secondary alopecia and functional impairment. [1] Trichotillomania can affect any body area, although exclusive involvement of the pubic area is very infrequent.
Background. Trichotillomania appears to be a fairly common disorder, with high rates of co-occurring anxiety disorders. Many individuals with trichotillomania also report that pulling worsens during periods of increased anxiety.
Compulsive hair pulling or Trichotillomania, is an impulse control behaviour that is categorised under Obsessive Compulsive Disorder and Related Disorders (OCD-R) in the Diagnostic and Statistical Manual (DSM5).
Trichotillomania (often abbreviated as TTM) is a mental health disorder where a person compulsively pulls out or breaks their own hair. This condition falls under the classification of obsessive-compulsive disorder (OCD).
Trichotillomania is on the obsessive-compulsive spectrum, which means that it shares many symptoms of obsessive-compulsive disorder (OCD), such as compulsive counting, checking, or washing.
Individuals with trichotillomania (TTM), a disorder characterized by repetitive pulling out of one's own hair, often have co-occurring ADHD, but little is known about this comorbidity. Additionally, there have been intimations in the literature that treatment of ADHD with stimulants may worsen TTM symptoms.
Noticeable hair loss, such as shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows. Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling. Biting, chewing or eating pulled-out hair.
Recently, a strong relationship of family chaos during childhood and trichotillomania has also been reported, in which 86% of women with trichotillomania reported a history of violence—for example, sexual assault or rape—concurrent with the onset of trichotillomania.
While people on the autistic spectrum often have comorbid trichotillomania and other BFRBs, the reverse correlation does not appear to hold true, and no scientific evidence could be found indicating that autism causes trichotillomania.
Trichotillomania has been found to be associated with mood disorders, particularly bipolar disorder. Trichotillomania has shared similarities with bipolar disorder by virtue of phenomenology, co-morbidity, and psychopharmacologic observations.
The most common prescription stimulants are methylphenidate (Ritalin®, Concerta®), lisdexamfetamine (Vyvanse®, Elvanse®), and amphetamine/dextroamphetamine combinations (Adderall®).
Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder - PMC. The .
It is commonly seen in depression and many other psychiatric disorders. Trichotillomania rarely occurs as a co morbid condition in patients with schizophrenia. Even rarer is recurrent hair pulling in response to psychotic symptoms in schizophrenia.
A study conducted in 2002 revealed a connection between trichotillomania and the individuals who experienced childhood trauma, or emotional neglect. This study shows that the people who suffer from trichotillomania were having higher levels of childhood trauma.
Although in most cases trauma leads to trichotillomania with sufferers feeling relief from the act of pulling, hair pulling is what then causes a repeat of the anxiety. The person afflicted with this condition feels an almost magnetic attraction between their fingers and their hair.
So, is trichotillomania inherited? Yes, it can be, but other factors also contribute to the condition. As research and studies continue, understanding of the causes of trichotillomania and other mental health disorders will increase and improve prevention and treatment options.
In people with trichotillomania, brain imaging studies have shown abnormalities in activity in certain regions of the brain, including areas involved in regulating impulses and habits, emotional processing, and reward processing. Neuroimaging research also points to abnormal activity in those with OCD.
Individuals with TTM will often avoid pulling in social situations and prefer to pull while alone or while engaged in sedentary activities, illustrating the ability to suppress pulling to avoid stigma. Creating a vicious circle, negative affective experiences such as stress and anxiety often exacerbate pulling.
Other imaging studies of trichotillomania reported reduced gray matter in the left inferior frontal gyrus23 and reduced cerebellar volumes. More recently, whole-brain analysis identified increased gray matter densities in the left caudate/putamen, bilateral cingulate, and right frontal cortices.
If untreated, trichotillomania is a chronic illness that often results in substantial psychosocial dysfunction and that can, in rare cases, lead to life-threatening medical problems. Control of the hair pulling is therefore critical for maintaining long-term health and quality of life.
The condition is more common in children ages 9–13 years than other age brackets. Older adolescents and teens with trichotillomania often experience increasingly severe symptoms the longer the condition is present.
There are two types of trichotillomania. One is called automatic pulling and the other is called focused pulling.