Trichotillomania: Current Issues in Conceptualization and Treatment

Keuthen, Nancy J.; OʼSullivan, Richard; Sprich-Buckminster, Susan

doi:10.1159/000012282

Cited by 38 publications

(25 citation statements)

References 128 publications

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“…Other differences are that hypochondriasis, by definition, is characterized by somatic sensations and perhaps poorer insight than OCD [15], although research on the latter issue is limited. Trichotillomania, like Tourette's disorder, is not characterized by prominent cognitions, and hair pulling is often noted to be pleasurable, unlike OCD compulsions [16] ( Table 1).…”

Section: Symptomsmentioning

confidence: 99%

The obsessive-compulsive spectrums

Phillips

2002

Psychiatric Clinics of North America

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The obsessive-compulsive (OC) spectrum is a fascinating concept that has captured the interest of researchers and clinicians alike. Although it has compelling merits, it is also controversial and bedeviled by many unresolved questions. For example, what disorders should be included in this spectrum? Should the Diagnostic and Statistical Manual of Mental Disorders (DSM) be reorganized to include a section of OC spectrum disorders (OCSDs) that includes obsessivecompulsive disorder (OCD) and putative spectrum disorders? How should we treat these disorders' delusional variants?This article addresses treatment approaches implied by this spectrum concept and the pros and cons of including this putative grouping of disorders in future editions of DSM. It also addresses two hypothesized spectrums that might be considered "subspectrums" of this OC spectrum. One spectrum, the compulsive/impulsive spectrum, views the OC spectrum along a dimension that ranges from compulsivity to impulsivity. The other is the delusionality spectrum, which is highly relevant to conceptualizations of the OC spectrum and other disorders (eg, the mood disorders). It has received far less attention than the OC spectrum itself or the compulsivity/ impulsivity spectrum, however. The delusionality spectrum poses particularly interesting classification dilemmas that will be addressed during the DSM-V process, and it has important and surprising implications for the treatment of OCD and certain OCSDs. Although other OC spectrums and subspectrums have been proposed, such as a "cognitive-motoric" dimension, which is a subspectrum that conceptualizes OCSDs as ranging from primarily obsessional to primarily motoric [1], these spectrums and subspectrums have received less attention than the others and are not discussed in this article.The following case highlights the clinical relevance of the spectrum concepts on which this article focuses and some of the theoretical and scientific issues they raise. CaseMr. A., a 47-year-old divorced white man, was obsessed with minor acne scars on his face, especially those on the bridge of his nose. Although he looked normal, he believed that the marks made him look like a monster and "as ugly as the Elephant Man." Mr. A. was occasionally able to acknowledge that his skin might look normal and that his view of his appearance might be distorted, but he was usually "100% convinced" that his belief was accurate. In addition to thinking about these perceived flaws for at least 10 hours a day, he performed repetitive behaviors, such as mirror checking and applying makeup to cover the marks. Mr. A. also had time-consuming and distressing obsessions that focused on whether he had placed various objects in exactly the right place, and he spent hours every day rearranging them. Mr. A. also had vocal and motor tics that consisted of repetitive hand movements,

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Section: Symptomsmentioning

confidence: 99%

The obsessive-compulsive spectrums

Phillips

2002

Psychiatric Clinics of North America

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“…Many different classes of psychotropic medications including antidepressants, mood stabilizers, and neuroleptics have had anecdotally reported success, but to date, randomized controlled trials are lacking. 22 …”

Section: Discussionmentioning

confidence: 99%

Gastric Trichobezoar: An Important Cause of Abdominal Pain Presenting to the Pediatric Emergency Department

Lynch¹,

Feola²,

Guenther³

2003

Pediatric Emergency Care

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Abdominal pain is a common presenting complaint of children seen in urgent care settings. It is the manifestation of a wide variety of disease processes ranging from benign to immediately life-threatening. Gastric bezoars are among the etiologies of chronic childhood abdominal pain that, when undiagnosed, may result acutely in serious complications, including gastric ulceration, bleeding and perforation, intussusception, and small bowel obstruction. To reinforce the importance of including this entity in the differential diagnosis of abdominal pain, we present the case of a 10-year-old girl with a history of chronic epigastric complaints who was ultimately presented with acute small bowel obstruction following fragmentation and distal migration of her gastric trichobezoar. Finally, we review and briefly summarize the current literature regarding the etiology, diagnosis, and management of this disorder in children.

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“…Increasing tension before pulling and/or pleasure, relief or gratification while pulling are not endorsed by about 20% of people suffering from clinically significant hairpulling (5). This finding has led to the recommendation that these two criteria be excluded from the diagnostic specifications (6).…”

Section: Diagnostic Criteria and Conceptualizationsmentioning

confidence: 99%