Trichotillomania, Research Paper Example

Abstract

Trichotillomania (TTM) is an impulse control disorder.  It is brought on by the urge to remove body hairs e.g. scalp, nose, eyebrows, facial hairs etc.  The disorder resembles addiction or compulsive disorders but as yet does not have a firm medical classification. This paper examines the nature of the disorder and covers:

• Key characteristics
• Potential treatments
• Epidemiology
• Future outlook

Characteristics

People that are diagnosed with Trichotillomania or TTM tend to live normal lives. Clinicians are describing this as an habitual problem that mainly occurs within teen groups. It is identified by bald spots that occur on the scalp or eyelashes, eyebrows or pubic hairs.  It is considered that stress is a strong influencing factor coupled with psychological problems of low self-esteem and lack of confidence. People with this problem also tend to be anti-social and avoid the company of others. Clinicians have yet to formally classify TTM but they are viewing it as a hybrid that resides within the realm of Obsessive Compulsive Disorder (OCD) and mental disorders.  (Christenson GA)

One of the most recent clinical studies into the behavioural characteristics of TTM was carried out in Shiraz, Iran. The study was conducted between the period of October 1993 to March 2003 over some 43 patients. Dermatologists and Psychotherapists conducted the study in Shiraz, particularly focusing in on the characteristics of the disorder.  They use personality questionnaires looking at the different aspects of personality. ” Although the foregoing report did not show any particular relationship between hair pulling and personality characteristics, such self-mutilating behaviour may not develop without any underlying psychological background. The

MMPI-2 seems to be less sensitive to normal aspect of personality and is more concerned with pathological aspects.” (H. Hagh-Shenas, 2004)

The study went on to examine other psychological areas that included schizophrenia and aspects of mental illness.

Potential Treatments

One of the more successful treatments has been associated with Habit Reversal Training (HRT). This is where the individual concerned is trained to recognise the urges or impulses and then re-direct them to doing something else. Patients are instructed to keep a journal of these events and record what they are thinking or doing at that time. This help the patients to ascertain what trends or common occurrences take place that stimulates the behavioural pattern.

Because of the low self-esteem and depression associated with this, clinicians have been prescribing drugs like Fluoexetine (Prozak) and clomiprammine and these have shown to improve the severity of  TTM.  More recent tests have shown encouraging results with acetylcysteine but like all drugs you have to examine the side effects and possible risk of addiction. Prozak has also been associated with suicides. Alternate treatments have included Hypnotherapy.

Others have looked at the 12 Step Recovery Model, similar to that adopted by Alcoholics Anonymous. This looks at the spiritual, physical and emotional challenges caused by behavioural addiction leading to the concept that TTM is indeed an impulsive control disorder

It is interesting to note that most of the cases of TTM are first observed by Dermatologists because of the skin complaints aggravated by the hair pulling.  Nevertheless, this does move more towards the field of Psychiatry and mental disturbance .. ” Far more articles on trichotillomania are found in psychiatric journals than in dermatological journals. However, dermatologists are more likely to see these patients before psychiatrists, and the number of trichotillomania patients seen in dermatologic clinics seems to be far greater than the number seen in psychiatric clinics.”  (Chull-Wan Ihm, 2009)

Epidemiology

TTM can be diagnosed within any specific age group or stage of life. It does, however, appear to be most common amongst  those between the ages of 9 to 14. Current evidence is now leading researchers to that of a genetic predisposition to the disorder. Current estimates indicate that between 3-5% of the worlds population suffer from this problem.  There does not seem to have been any “zeroing in” on whether this impacts any specific country more than others or whether there are any common factors that trigger the stimulus.  There have been some links to neorodegenerating diseases but insufficient research has been conducted in this area…” However, only very limited numbers of patients with trichotillomania have obsessive-compulsive disorder, in which obsessions are a central feature. Reports also suggest a possible association between neurodegenerating diseases, such as Parkinson disease, and trichotillomania; however, too few cases are reported to warrant an evaluation.”  (Chull-Wan Ihm, 2009)

Future Outlook

• In younger children the future outlook is better as the habitual symptoms are easier to treat and subsequently reverse
• In late childhood and adolescence the outlook is still pretty good but much more reserved because of potential psychological considerations. The chances of a potential recurrence are much more likely at this age
• In adult cases the outlook is poor and is unlikely to change and permanent recovery is uncommon

Works Cited

Christenson GA, M. T. (1991). A placebo controlled double-blind crossover study of fluoxetine in Trichotillomania. Psychiatry , 1556-71.

Chull-Wan Ihm, M. (2009). Trichotillomania. e-Medicine .

Hagh-Shenas, A. M. (2004). Trichotillomania-Associated Personality. IJMS , 105-108.