Trichotillomania Definition/description • • • An irresistible compulsion to pull one’s hair A form of traumatic alopecia May be present in conjunction with other repetitive grooming behaviours e.g. nail biting and skin picking. Epidemiology • • More common females Onset: usually in adolescents following a stressful event - But can happen at any age Aetiology • • • • • • • • Coping mechanism for anxiety and stressful events Benign habit that developed from a sensory event e.g. itchy eyelashes or another event Serotonin deficiency Genetic susceptibility Structural brain abnormalities Abnormal brain metabolism Psychological factors Disordered reward processing Clinical Features • • Hair loss - Scalp (most common) - Eyebrows - Eyelashes Pattern of hair loss is usually patchy, with hair of different lengths Diagnosis A. Recurrent pulling out of one’s hair, resulting in hair loss. B. Repeated attempts to decrease or stop hair pulling. C. The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The hair pulling or hair loss is not attributable to another medical condition (e.g., a dermatological condition). E. The hair pulling is not better explained by the symptoms of another mental disorder (e.g., attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder). DDx • Alopecia Treatment and Management • • • • • • • • • CBT - Habit reversible therapy Self-monitoring Completing reaction training Relaxation training Shaving and cutting nails - May be helpful in changing behaviour SSRIs - Limited evidence Anti-depressants Diet and activity - No specific diet required - Physical exercise can provide healthier outlets for stress Reduction of activities where patient may be involved in hair pulling: - Watching television - Reading - Talking on the phone - Lying in bed - Driving - Writing or doing paperwork