Trichotillomania

INTRODUCTION-

It is also known as ‘TRICH’ which is mainly characterized by recurrent pulling out of one’s own hair without any cosmetic reasons from different parts like scalp or any other part of the body (eyebrows, eyelids, etc.) resulting in hair loss eventually where person changes sites of pulling the hair over time.

For some patients this is somewhat happens without their perception while others are more conscious of their action but they are unable to control it  which is mainly triggered by obsessions or concerns about their outlook as in body dysmorphic disorder which may be followed by a feeling of tension or anxiety mostly quenched by the hair pulling

Prevalance-

 Just before or after puberty it starts typically.

About 1 to 2% of people have this disorder at any time, as per study about 80 to 90% of total patients are female.

 Sign and Symptoms –

1)Patients have uncontrolled impulses to pull out their hairs. It is chronic in nature which keeps on waxing and waning if not attended on time.

2) Different patterns of hair loss is seen which ranges from complete alopecia to merely thinned out hair, it depends on the case .

3)Wide range of activities may accompany hair pulling in different individuals like they may search fastidiously for a particular kind of hair or way to pull them like they roll the hair between their fingers, pull the strands between their teeth, or bite the hair in many cases when swallow they results in ‘trichobezoars’ .

4) They may feel ashamed because of their appearance or their inability to control their impulses. Most of the time they try to camouflage it by wearing wigs or scarfs to cover affected areas at the same time they may avoid confrontations where people may notices them , so typically they avoid picking their hairs in front of others with exception of closed ones.

5) Sometimes patients present it as picking of hair of others too or from pets or any fibrous material strand, etc., so in such cases complete case history is very important to avoid any wrong diagnosis.

6) During case taking most of the time patients also suffers from repetitive activities mainly focused on body like skin picking, etc. at the same time they have emotional or mental issues too like major depressive disorder, etc.

Diagnosis of Trichotillomania-

A)Clinical criteria

It typically includes-

1) Hair loss is seen as a result of picking of hair.

2) Repeated attempts by patient

3)Experiencing significant distress or impairment in functioning from the activity

4)The distress can include feelings of embarrassment or shame (eg, due to loss of control of one’s behavior or the cosmetic consequences of the hair loss).

Treatment of Trichotillomania-

1)Medication should be given in form of  SSRIs (Selective serotonin reuptake inhibitors)  or clomipramine and other medications are given according to case it  is proved efficient especially where patients suffers from coexisting depression or anxiety disorders.

2) Most important is inclusion of mental and emotional therapies in which priority is given to Cognitive-behavior therapy which is usually a habit reversal training given to the patients under guidance to control their uncontrollable impulses voluntarily by developing their will.

Under Habit reversal training which is a predominantly behavior therapy is actually provided by expert counsellor which includes-

A) Training regarding awareness about their own disorders and all the exciting factors, how to identify them, etc. Stimulus control (modifying situations—eg, avoiding triggers—to reduce the frequency of initiation of pulling out of hair)

b) Last but not the least is ‘Competing response training’ where patients are guided to substitute their impulse to pull out hairs to other activities, such as knitting, siting on their own hand, etc.  and counselling of family members too so as to provide emotional support and encouragement to them.

The ultimate aim of treatment and therapy in this disorder is to help patients replace a bad habit with something that’s not harmful and more and less control their habit for good.

                        HAPPY LEARNING

Contributor- Dr. Apurva Varangi