We explain the symptoms and possible causes of this obsessive-compulsive disorder.
Trichotillomania is a disorder that involves compulsive hair pulling , causing noticeable hair loss.
Many times, the person feels a kind of overwhelming desire to carry out such behavior, and a subsequent feeling of relief or pleasure after it.
It is associated with moments of stress, and can sometimes be accompanied by a lack of resources or tools when managing these moments of tension. In this article we will know what this picture consists of, characteristics, causes and possible treatments.
- Recommended article: “The 10 most common psychological disorders”
Trichotillomania: type of disorder
Trichotillomania is a mental disorder listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders). In the 4th edition of the manual (DSM-IV-TR), trichotillomania was classified as an impulse control disorder, specifically, it was located in the disorders not included in other sections of this category.
However, in the 5th and latest edition of the manual (DSM-5) there is a change, and trichotillomania is classified as an obsessive-compulsive disorder (along with obsessive-compulsive disorder, hoarding disorder, excoriation disorder, and obsessive-compulsive disorder). body dysmorphic, among others).
What does it consist of?
But what exactly is trichotillomania?
It is a pathology characterized by a recurrent hair pulling, which causes a perceptible and important loss of it. The plucking can be from any area of the body that has hair, although the most common is the head (especially in women; men, on the other hand, tend to pluck it from any area of the body with hair), but it is also common see it on eyebrows and even eyelashes.
This hair loss results in depopulated areas of the scalp , or even in eyebrows with empty pieces, etc. Pulling out is also compulsive, becoming an irrepressible and uncontrollable habit for the patient (in fact, that is why trichotillomania was previously classified as an impulse control disorder).
Signs and symptoms
The person who suffers from it is unable to resist the urge to pull out their hair ; this is evidenced by a feeling of tension in the moment before starting, and with a subsequent feeling of pleasure during and/or after doing so. This last characteristic is proposed by the DSM-IV-TR; however, in the DSM-5 it is also specified that the person tries to reduce or stop the pulling.
On the other hand, that sensation that the person with trichotillomania has of tension and subsequent pleasure that we have mentioned, is eliminated as a criterion in the DSM-5. In addition, the person with trichotillomania feels significant discomfort caused by the disorder itself.
Like all mental disorders in the DSM, trichotillomania should not be better explained by any other mental disorder or general medical condition
Characteristic
The prevalence of trichotillomania is oscillated between 1 and 2%. It affects women much more frequently than men , in a ratio of 10:1 (in adults). In children, on the other hand, the prevalence is equal between boys and girls.
The most common onset of trichotillomania is puberty. Its course is usually chronic, and it frequently appears comorbid to OCD (Obsessive Compulsive Disorder), MDD (Body Dysmorphic Disorder), and excoriation disorder (all of them also disorders located as “obsessive-compulsive disorders” in the DSM -5.
On the other hand, 68% of cases diagnosed with trichotillomania have a family member with more or less severe depressive symptoms.
Causes
In relation to the etiology of trichotillomania, it is thought that there is a certain biological vulnerability in people who suffer from it ; It is also known that the orbitofrontal cortex and the basal ganglia are involved in this disorder.
In addition, the orbitofrontal cortex is related to a repetitive pattern of behavior. The corticostriatal pathways, which are related to visuospatial alterations, have also been implicated.
On the other hand, stressful events (or stress itself) are considered triggering factors for trichotillomania (or episodes thereof).
Two authors, Greenberg and Sarner, referred to the family and family dynamics to explain the etiology (or causes) of trichotillomania. They talked about three components:
- Presence of a hostile, intolerant, aggressive and competitive mother.
- Presence of an inhibited and absent father.
- Existence of ambivalent mother-daughter relationships.
Finally, another possible cause of trichotillomania that has been alluded to is borderline personality traits.
Treatment
Fortunately, trichotillomania can be treated, and it doesn’t have to become a chronic disorder . Regarding its treatment, a series of psychological measures are used, including behavioral therapy and the habit reversal technique, together with complementary psychopharmacological measures (SSRI antidepressants [selective serotonin reuptake inhibitors] are used), clomipramine , anxiolytics, antipsychotics and lithium).
These two types of treatments (psychological and pharmacological) are added to a series of dermatological measures, which include the administration of steroids and antihistamines.
At the level of efficacy in relation to psychological intervention, although behavior therapy is considered effective, there are few studies in this regard; Regarding the habit reversal technique, there is a controlled and randomized study that supports it as an effective technique.
Bibliographic references
- APA (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders . Madrid. Pan American.
- Belloch, A.; Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume II. Madrid: McGraw-Hill.
- Perez, M.; Fernandez, JR; Fernandez, C. and Friend, I. (2010). Guide to effective psychological treatments I and II.
- Vallejo, MA (2012). Behavior Therapy Manual. Volume II. Madrid: Dykinson.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.