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07-SEPTEMBER-2008 03:17:44 - Trichotillomania Not to be confused with Trichomoniasis. Trichotillomania Classification and external resources ICD-10 F63.3 ICD-9 312.39 DiseasesDB 29681 MedlinePlus 001517 eMedicine derm/433 ped/2298 Trichotillomania TTM, or trich as it is commonly known, is an impulse control disorder characterized by the repeated urge to pull out scalp hair, eyelashes, facial hair, nose hair, pubic hair, eyebrows or other body hair, sometimes resulting in noticeable bald patches. Trichotillomania is classified in the DSM-IV as an impulse control disorder, but there are still questions about how it should be classified. It may seem, at times, to resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichototillomania often begins during the individual's teenage years. Depression or stress can trigger the trich. Due to social implications the disorder is often unreported and it is difficult to predict accurately prevalence of trichotillomania; 2.5 million in the U.S. may have TTM, with a 1% prevalence rate.1 The name derives from Greek: tricho- hair, tillen to pull, and mania. Contents 1 Characteristics 2 Treatment 3 Epidemiology 4 Genetics 5 See also 6 Notes 7 Further reading 8 External links Characteristics Individuals with trichotillomania live relatively normal lives; however, they may have bald spots on their head, among their eyelashes, pubic hair, or brows. An additional psychological effect can be low self-esteem, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress-related component. In low-stress environments, some exhibit no symptoms known as 'pulling' whatsoever. This 'pulling' often resumes upon leaving this environment.2 Many clinicians classify TTM as a habit behavior, in the same family as nail biting onychophagia or compulsive skin picking dermatillomania. These disorders are a cross between mental disorders, such as obsessive compulsive disorder OCD because the sight or feel of a body part causes the individual anxiety, and physical disorders such as stereotypic movement disorder because the person performs repetitive movements without being bothered by or completely aware of them. The current classification of trich as an impulse disorder with pyromania, pathological gambling and kleptomania, has been called into question as inadequate and in need of revision.3 One study showed that individuals with TTM have decreased cerebellar volume.4 Anxiety, depression and OCD are more frequently encountered in people with TTM.5 People with TTM may also eat/chew the roots of the hair that they pull, referred to as trichophagia. In extreme cases this can lead to Rapunzel syndrome, and even death.678 Some individuals with TTM may feel they are the only person with this problem due to low rates of reportage.9 Treatment Habit Reversal Training or HRT, has been shown to be a successful adjunct to medication as a way to treat TTM.10 With Habit Reversal Training, doctors train the individual to learn to recognize their impulse to pull and also teach them to redirect this impulse. As a part of the behavioral record-keeping component of HRT, patients are often instructed to keep a journal of their hair-pulling episodes. They may be asked to record the date, time, location, and number of hairs pulled, as well what they are thinking or feeling at the time. This can help the patient learn to identify situations where they commonly pull out their hair and develop strategies for avoiding episodes. Treatment with Clomipramine, a tricyclic antidepressant, was shown in a small double-blind study to significantly improve symptoms.11 Fluoxetine Prozac and other similar SSRI drugs have limited usefulness in treating TTM, and can often have significant side effects.12 According to F. Penzel, antidepressants can even increase the severity of the TTM.3 Epidemiology TTM is diagnosed in all age groups; it is more common during the first two decades of life, with mean age of onset usually reported between 9 and 13 years of age. Among preschool children the genders are equally represented; there appears to be a female predominance among preadolescents to young adults, with between 70% and 93% of patients being female.13 Evidence now points to a genetic predisposition.1415 The number of reported trichotillomania cases has increased throughout the years, possibly due to a reduced stigma associated with the condition. Estimates of the number of persons with TTM range from 1-3%16 up to 5%15 of the world's population. Genetics When genes that were suspected to cause trichotillomania were injected into laboratory mice in one study, the mice obsessively pulled out their fur and the fur of other mice in the cage.17 See also Dermatillomania Onychophagia Dermatophagia Notes ^ Diefenbach, G.J., Reitman, D. Williamson, D.A., 2000. Trichotillomania: A challenge to research and practice. Clinical Psychology Review 20 20: 289-309. doi:10.1016/S0272-73589800083-X. ^ Christenson GA, Mackenzie TB, Mitchell JE 1991. Characteristics of 60 adult chronic hair pullers. The American journal of psychiatry 148 3: 365-70. PMID 1992841. ^ a b Penzel 2003 The Hair-Pulling Problem: A Complete Guide to Trichotillomania; Oxford University Press, p. 3. ISBN 0-19-514942-4 ^ Keuthen NJ, Makris N, Schlerf JE, et al 2007. Evidence for reduced cerebellar volumes in trichotillomania. Biol. Psychiatry 61 3: 374-81. doi:10.1016/j.biopsych.2006.06.013. PMID 16945351. ^ Christenson GA, Crow SJ 1996. The characterization and treatment of trichotillomania. The Journal of clinical psychiatry 57 Suppl 8: 42-7; discussion 48-9. PMID 8698680. ^ Ventura DE, Herbella FA, Schettini ST, Delmonte C 2005. Rapunzel syndrome with a fatal outcome in a neglected child. J. Pediatr. Surg. 40 10: 1665-7. doi:10.1016/j.jpedsurg.2005.06.038. PMID 16227005. ^ Pul N, Pul M 1996. The Rapunzel syndrome trichobezoar causing gastric perforation in a child: a case report. Eur. J. Pediatr. 155 1: 18-9. PMID 8750804. ^ Hairball kills teenager. hairgrowthnews.com. Retrieved on 2007-08-11. ^ Christenson GA, MacKenzie TB, Mitchell JE 1994. Adult men and women with trichotillomania. A comparison of male and female characteristics. Psychosomatics 35 2: 142-9. PMID 8171173. ^ Woods DW, Wetterneck CT, Flessner CA 2006. A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour research and therapy 44 5: 639-56. doi:10.1016/j.brat.2005.05.006. PMID 16039603. ^ Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL 1989. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania hair pulling. N. Engl. J. Med. 321 8: 497-501. PMID 2761586. ^ Christenson GA, Mackenzie TB, Mitchell JE, Callies AL November 1991. A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania. Am J Psychiatry 148 11: 1566-71. PMID 1928474. ^ Sah DE, Koo J, Price VH 2008. Trichotillomania. Dermatol Ther 21 1: 13-21. doi:10.1111/j.1529-8019.2008.00165.x. PMID 18318881. ^ Entrez Gene: HOXB8 homeobox B8 Homo sapiens . National Center for Biotechnology Information August 12, 2006. Retrieved on 2007-11-13. ^ a b Hair pulling disorder gene found. BBC News 29 September 2006. Retrieved on 2007-05-01. ^ Christenson GA, Mackenzie TB, Mitchell JE 1991. Characteristics of 60 adult chronic hair pullers. Am J Psychiatry. 148 3: 365-70. ^ Howard Hughes Medical Institute 2008-05-01. Gene Targeting, Homeobox Genes, Development, and Behavior. Press release. Retrieved on 2008-07-12. Further reading Keuthen, Stein, Christensen Christenson 2001 Help for Hair Pullers: Understanding and Coping With Trichotillomania; New Harbinger Publications, ISBN 1-57224-232-9 Parker Ed. 2004 Trichotillomania - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References ; Icon Health Publications, ISBN 0-597-84664-2 Stein Ed., Christenson Ed. Hollander Ed. 1999 Trichotillomania; American Psychiatric Press, ISBN 0-88048-759-3 External links Trichotillomania at the Open Directory Project Trichotillomania Learning Center Psychiatric Times article v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Trichotillomania Categories: Impulse-control disorder not elsewhere classified | Hair-related diseases | Anxiety disorders Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Dansk Deutsch Español Français Italiano עברית Nederlands 日本語 Polski Português Simple English Srpskohrvatski / СрпÑ?кохрватÑ?ки Suomi This page was last modified on 14 August 2008, at 00:08
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