Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling

Abstract

The average age of onset for trichotillomania is 12, with this disorder most commonly first seen between ages 10 to 13 (12). Hair pulling generally takes place in one or more areas, with the most common Abstract Trichotillomania, or hair-pulling disorder, is classified as an obsessive-compulsive spectrum disorder and is seen predominantly in females. This is a non-systematic review article focusing on the psychopathological features of hair pulling. It is speculated that hair pulling may function to provide short-term relief from stress and other unwanted emotional states, thus serving as a method of emotion regulation. The prevalence of trichotillomania ranges from 1 to 3%. The most targeted site is the scalp, and other common areas include pubic hair and facial regions such as the eyebrows, eyelashes, and beard. Individuals suffering from this disorder tend to avoid social environments due to embarrassment regarding their appearance and fears of being judged by peers. Trichotillomania is associated with significant functional impairment and increased risks of comorbid psychiatric disorders such as other body-focused repetitive behaviors, depression, anxiety, and addictive disorders. This article reviews the epidemiology, clinical features, diagnostic criteria, and psychopathology of trichotillomania with an emphasis on psychopathology and psychiatric comorbidity.

Recent advances in the treatment of trichotillomania (hair‐pulling disorder)

“…Many previous smaller studies have found the mean age of onset to be closer to 10 to 13 years 9 . The age of onset closer to puberty, in addition to the female predominance noted by some studies, may better support the hormonal aspects of TTM discussed in some articles 6,7,10 …”

“…9 The age of onset closer to puberty, in addition to the female predominance noted by some studies, may better support the hormonal aspects of TTM discussed in some articles. 6,7,10 The most common sites where patients with TTM pull hair from are the scalp, eyebrows, and pubic region, eyelashes, and beard. 2,11 Dermoscopic features of TTM include decreased hair density, broken hairs of different shaft lengths, coiled or short vellus hairs, trichoptilosis (split hairs), occasional yellow dots, and no exclamation mark hairs as would be seen in alopecia areata.…”

“…10 CBT to be significantly more effective than group support therapy. 24 T A B L E 1 Clinical differentials for TTM 1,2,5,6,9,11,12…”

“…However, recent advances in treatment have been seen, especially regarding the use of glutamatergic medications. 6…”

“…Many of the pharmacologic treatments used for other psychiatric conditions have historically been inadequate in the treatment of TTM, and there are no Food and Drug Administration (FDA)‐approved medications for this purpose. However, recent advances in treatment have been seen, especially regarding the use of glutamatergic medications 6 …”