Trichotillomania
The Medical Mystery

     Trichotillomania may truly be one of the medical mysteries of our time because there is really no deciding factor in why it exists to begin with. Unquestionably doctors and scientists know what it is and in many cases can control it with behavior therapy or medications but why the repetitive activity occurs is quite perplexing. The disorder may have its anchors in genetics or some neurological disorder yet unexplained. If anything it has similarities to Tourette’s syndrome but the explanations for that have been studied for many years. Plus with trichotillomania there is some degree of self-control involved because the individual will often engage in the behavior only when alone as compared to other neurological tics. On the other hand though the individual is seemingly quite powerless to stop it which may arise from a conditioned response or repetitive brain signals. Regardless of this many medical abnormalities can only be treated by focusing on symptom reduction to control the disorder.

What is Trichotillomania?

     Well it’s essentially classified as an impulse control disorder or tic where the individual has an irresistible urge to engage in the pulling or plucking of hair on the scalp but can involve hair anywhere on the body. Even though it has been associated with obsessive compulsive disorders (OCD) where there is a rise in psychological tension prior to the behavior and a reduction in this tension after the plucking there are many cases that completely defy this theory. The simple reason why is some people are totally unaware they are even engaged in the behavior similar to those who chew their fingernails. What’s even more baffling is the disorder can occur in any age group but is most controllable in young adults or children.

     The term trichotillomania was first coined in 1889 by the French dermatologist Francois Henri Hallopeau and essentially means “hair pulling mania.” There are records of this hair plucking behavior dating back to the ancient Greek physician Hypocrites.

Causes of Trichotillomania

     Theories and research as to what triggers this disorder are abundant and in many cases the origin might be found in multiple disciplines. What is clear though is many individuals suffering from this disorder often experience anxiety, depression, and other obsessive-compulsive behaviors. Some of this could result from the individuals’ fear of being discovered or the belief that it is not an appropriate activity to engage in to begin with. Other theories range from stress triggering the hair pulling to the idea it is just another form of addiction. Even though trichotillomania has similarities to some neurological orders it equally expresses itself as being atypical. Plus even though some theories espouse this disorder as originating from genetics or even the size of the brain none of this has ever been scientifically proven over a large number of cases.

Diagnosis

     Trichotillomania may be difficult to diagnose because if the individual has escaped detection through their teenage years then they likely have established methods in adulthood for it to go undetected or unobserved. In other words the activity has likely become entrenched. Camouflage techniques have likely emerged ranging from hats and wigs to eyeliners that disguise eyebrow plucking. Often times though the activity is caught in the earlier years when the individual or parents expose the activity to a dermatologist.

     The typical dermatologist unless they specialize in the disorder will first rule out any other scalp disorder or infection that might be present. This can include patchy baldness such as alopecia areata, the telogen effluviums, traction alopecia, or infections like tinea capitis. The distinction with these conditions can be quite evident because with trichotillomania the hair cannot be easily pulled out as with some of these conditions. A biopsy may be performed but usually the condition exhibits itself with dried blood, redness of the scalp from recently pulled hair, empty follicle openings, malformed hair from the twisting, or just the typical uneven hair growth. All of this is readily observable to the trained eyes of a doctor with an overhead lamp and magnifying platform.

Symptoms of Trichotillomania

· An overwhelming urge to pluck or pull hair from any part of the body.

· Patchy bald spots or uneven hair growth exhibited mainly on the scalp or eyebrows.

· Camouflaging of the affected areas with hats and wigs.

· A tremendous sense of relief or fulfillment once the hair is plucked.

· Continually playing with, chewing, or even swallowing of the hair that has been plucked.

· Bowel blockage if the individual is swallowing the hair.

Complications

     The chief complication to the physical body tends to be infection that is rooted in the hair pulling. The psychological and social impact of the disorder can be immense with lowered self-esteem and withdrawal from normal activities. That alone may result in the sufferer harming themselves because of their inability to control the situation. Also quite a few individuals who pull their hair and chew on it have a tendency to eventually swallow it. This can lead to serious intestinal blockage which requires admission to a hospital.

Groups Affected

     Trichotillomania can affect any age group or sex but after young adulthood ninety percent of the sufferers are likely to be women. If caught in the early childhood years the affliction tends to be self-limiting. The cure at that point seems to be parental discipline or the proper referral to medical specialists. It goes without saying that most habits, if it is just that, can be trained out of an individual in the formative years or in the early stages of developing a repetitive routine. Unfortunately with most patients over the age of thirty this disorder tends to be a lifelong event.

Treatment for Trichotillomania

     Treatment approaches for this disorder can involve a variety of methods ranging from support groups to behavior modification and medications. Alternative therapies can encompass yoga, hypnosis, prayer, meditation, herbs and vitamins, and nutritional changes. In regard to medications the drug of choice among physicians is Anafranil (clomipramine) which is one of the older anti-depressants in the tricyclic group. None of the Serotonin Reuptake Inhibitors have shown themselves to be as effective as the mentioned. The problem with the drug route is many times it seems to work initially but the gains tend to be temporary though some do experience a long term cure. Because of this specialists feel a combination of medications and behavioral therapies is the best answer. Habit reversal training has shown great promise if the symptoms are caught early enough. N-Acetylcysteine has shown promise as a dietary substance for control of the symptoms and opens the door to many possibilities for natural treatments that have not been pursued.

The Future

     Trichotillomania will likely remain a baffling medical anomaly in the foreseeable future and remain categorized among the many obsessive-compulsive disorders. Even among the many people who suffer from trichotillomania it is generally recognized that without widespread exposure research funding for a cure will likely remain limited. Plus due to the fact many choose to conceal the symptoms we would tend to agree. Without a doubt the emotional, mental, and physical strains of this condition are immense.

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