Trichotillomania
What is Trichotillomania?
Trichotillomania is the uncontrollable plucking of one’s hair. Although usually limited to hair on the head, removal of eyebrows, eyelashes and other body hair is not uncommon. The practice results in signficant, and sometimes complete, hairloss.
Official Criteria
The DSM-IVR includes 5 criterion that must be present for the diagnosis:
- Recurrent plucking of one's hair resulting in noticeable hair loss
- Increasing build-up of tension immediately before the plucking which is is follow by:
- Sense of relief or reduction in tension when the hair is pulled
- The problem is not better explained by an alternative mental or medical disorder
- The problem results in signficant distress or impairment to the individual in social, vocational or other areas of life
Prevalence
Although present in both men and women, the behaviour tends to be reported to health professionals by more women than men. Statistics indicate that between .6 –3% of women may suffer from this disorder, as opposed to between 0.6 –1.5% of men.
Manifestation
The behaviour is rarely carried out in public although family members may be aware of it. Individuals will often deny the behaviour when confronted. Ironically, the individual often appears not to be aware that they are doing it and does not report pain from the plucking. When the hair is plucked, it may be used to repititiously caress the lips or cheeks or be eaten. There can be a ritualistic quality to the latter.
Ingestion of the hair can result in the formation of hairballs and lead to gastroinstestinal or other medical problems.
The amount of hair loss can be variable as can the episodes of plucking. Excessvie hair loss by plucking is often disguised with the use of wigs, hairpieces, and headgear.
Co-morbidity
It is not uncommon for Trichotillomania to co-exist with a number of other mental health problems, predominately Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Substance Abuse, Eating Disorders and Major Depressive Disorder.
Treatment
Since Trichotillomania is currently thought to be a variation of Obsessive Compulsive Disorder (OCD), similiar types of treatments are used. Behavioural therapy, stress reduction, and psychotherapy are used either singularly or in conjunction with pharmacological treatments such as SSRI’s (eg. Prozac).
Further Reading
Favazza, A. (1992). Repetitive self-mutilation. Psychiatric Annals, 22, 60-63.
Favazza, A. (1995). Self-mutilation. In E. Hollander (Ed.) Impulsivity and aggression. (pp. 185-200). New York: Wiley.
Krishnan, K., Davidson, J. & Guarjardo, C. (1985). Trichotillomania: A review. Comprehensive Psychiatry, 26, 123-128.
Pattison, M. & Kahan, J. (1983). The deliberate self-harm syndrome. American Journal of Psychiatry, 140, 867-872.
Swedo, S.E.. (1993). Trichotillomania. In E. Hollander (Ed.), Obsessive-compulsive related disorders (pp. 93-112). Washington, DC: American Psychiatric Press.
Winchell, R., (1992). Trichotillomania: Presentation and Treatment. Psychiatric Annals, 22, 84-89.
Other Resources:
Therapy for Sexual Impulsivity: The Paraphilias and Paraphilia-Related Disorders. Martin Kafka, MD, Psychiatric Times (on-line)
© Stephen Hucker, MB,BS, FRCP(C), FRCPsych 2003, 2004,2005
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