Trichotillomania in the broadest sense is self induced loss of hair. It
is classified in DSM-IV as an nerve impulse control disorder with
pyromania pathological gambling and kleptomania and includes the
criterion of an increasing sense of tension before pulling the hair and
gratification or relief when pulling the hair. However some people with
trichotillomania do not endorse the increase of rising tension and
subsequent pleasure gratification or relief as part of the criteria because many individuals with
trichotillomania may not realize they are pulling their hair patients
presenting for diagnosis may deny the criteria for tension prior to hair
pulling or a sense of gratification after hair is pulled.Trichotillomania
has been hypothesized to position on the obsessive compulsive
spectrum(OCD) which is proposed to encompass obsessive compulsive
disorder nail biting and skin picking tic disorders and eating
disorders. These conditions may share clinical features genetic
contributions and possibly treatment reception however differences
between trichotillomania and OCD are present in symptoms neural function
and cognitive profile. In the sense that it is associated with
irresistible urges to execute unwanted repetitive behavior
trichotillomania is akin to some of these conditions and rates of
trichotillomania among relatives of OCD patients is higher than expected
by chance. When it occurs in early childhood it can be regarded as a
clear cut clinical entity.
Trichotillomania is often not a focused
act but quite hair pulling occurs in a trance like state hence
trichotillomania is subdivided into automatic versus focused hair
pulling. Children are more often in the automatic or unconscious subtype
and may not consciously remember pulling their hair. Other individuals
may have focused or conscious rituals associated with hair clouting
including seeking specific types of hairs to clout clouting until the
hair feels just right or clouting in response to a specific sensation.
Knowledge of the subtype is helpful in determining handling strategies.
Individuals
with trichotillomania exhibit hair of differing lengths; some are
broken hairs with blunt ends some raw growth with tapered ends some
broken mid shaft or some uneven stubble. Scaling on the scalp is not
present overall hair density is normal and a hair device test is
negative (the hair does not device out easily). Hair is often pulled out
leaving an unusual shape; individuals with trichotillomania may be
secretive or shameful of the hair pull behavior.
Other medical
complications include infection permanent loss of hair repetitive
stress injury carpal tunnel syndrome and gastrointestinal obstruction as
a result of trichophagia. In trichophagia family with trichotillomania
also ingest the hair that they pull in extreme and rare cases this can
lead to a hair ball (trichobezoar). Rapunzel syndrome an extreme form of
trichobezoar in which the tail of the hair globe extends into the
intestines can be fatal if misdiagnosed.
Environment is a big
factor which affects hair pulling. Sedentary activities such as being in
a relaxed environment are contributing to hair pulling. A common
example of a sedentary activity promoting body covering pulling is lying
in a bed while trying to rest or fall asleep. An extreme example of
automatic TTM is found when some patients have been ascertained to pull
their hair out while asleep. This is named sleep isolated
trichotillomania.
No comments:
Post a Comment