Psychopathology
and Treatment
Probable
Diagnosis: Trichotillomania
Psychopathology
Profile
►
Prevalence: Between 0.6 percent to 3.0 percent of
people in the
► Gender differences: Among
adults, females who receive a diagnosis of trichotillomania
outnumber males by 2 to 1. Among children, the prevalence of the disorder is
the same for girls and boys.
►
Racial/Ethnic differences: Unclear
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Special points on trichotillomania
− In trichotillomania,
the most common sites of hair pulling are the scalp (as in Liz’s case),
eyebrows, and eyelashes.
− Trichotillomania
is listed in DSM-IV-TR as an impulse-control disorder, along
with kleptomania, pyromania, pathological gambling, and intermittent explosive
disorder. It is considered an impulse-control disorder because the following
features dominate: failure to resist an impulse, drive, or temptation to
perform a harmful act; increasing tension or arousal before performing the act;
pleasure, gratification, or relief when performing the act.
− Some clinicians believe that trichotillomania should instead be listed as an obsessivecompulsive disorder. In
support of this notion, trichotillomania and various
forms of OCD often run in the same families, OCD medications often are helpful
in cases of - 29 - trichotillomania, and OCD behavioral treatments are
helpful in some cases of trichotillomania. On the
other hand, some of the brain activity that accompanies trichotillomania
behavior (for example, activation of the brain’s pleasure center) may be different
from that which accompanies other forms of OCD.
− Some individuals with trichotillomania also bite their nails or pick their skin compulsively.
And some experience depression and/or anxiety. As indicated in the video case,
there is growing evidence that trichotillomania is
related in part to biochemical abnormalities in the brain, perhaps genetically
produced. Such abnormalities may lead to symptoms of the disorder when the
individual further experiences periods or instances of stress.
Treatment
Profile
► A
combination of behavioral and cognitive techniques can be helpful in cases of trichotillomania, particularly techniques that (1) help
individuals recognize their urge to pull hair before it becomes too strong to
resist, (2) substitute incompatible behaviors for hair pulling (for example,
keeping one’s hands busy squeezing a stress ball), and (3) expose individuals
to anxiety-arousing situations while preventing them from pulling their hair
(in Liz’s case, for example, the glued-on wig helped prevent hair pulling, forcing
her to cope with stressors or upsets by other means).
► Serotonin-enhancing
antidepressant drugs help bring about symptom
reduction in some cases.
► The rate of effectiveness of these approaches is not clear.