Trichotillomania

Trichotillomania involves the repetitive, uncontrollable pulling of one’s body hair. Most commonly, scalp hair, eyelashes, and eyebrows are pulled, although hair may be pulled from any location. Typical symptoms include:

Recurrent pulling out of one's hair resulting in noticeable hair loss.

An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.

Pleasure, gratification, or relief when pulling out the hair.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).

Associated Features:

Associated features of Trichotillomania include: examining the hair root; twirling it off; pulling the strand between the teeth, or trichophagia (eating hairs). Nail biting, scratching, gnawing, and excoriation may be associated with Trichotillomania.

Mood Disorder
Anxiety Disorder
Mental Retardation.

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Obsessive-Compulsive Disorder
Tourette's Syndrome
Pervasive Developmental Disorder (Infantile Autism)
Stereotypy Disorder
Factitious Disorder (Munchausen Syndrome)

Cause:

Trichotillomania is found predominantly in females and tends to occur more often in children than adults. The disorder usually begins between early childhood and adolescence. In some cases, trichotillomania is related to an increased stress level at home or school, while for other children, it is simply a learned habit that has strengthened over time.

Treatment:

The primary treatment approach for Trichotillomania is habit reversal combined with stress management and behavioral contracting. Parents can help by recognizing the problem in its early stages and getting involved in its treatment.

Counseling and Psychotherapy [ See Therapy Section ]:

Treatment may involve self-monitoring of hair-pulling episodes as well as the feelings and situations that are most likely to lead to hair pulling. Youngsters are then systematically introduced to new behaviors, for example, squeezing a ball or tightening their fist, whenever they feel the urge to pull at their hair.

Relaxation training and other stress reduction techniques may also be used including reward charts that help track and monitor a child's progress with the added incentive of earning small rewards for continued progress. In addition, cognitive therapy, is found to be effective.