Trichotillomania

SUPERVISOR :
DOKTER IWAN SYS, SP.KJ

Tanty Tunjung Sari 201620401011103

Intan Putri Hadiyanti 201620401011107

PSYCHIATRY
MEDICAL FACULTY OF UNIVERSITY OF MUHAMMADIYAH MALANG
2017
Definition
Trichotillomania is characterized by repetitive hair pulling resulting in significant hair loss,
distress, and social and/or occupational impairment.

Trichotillomania is characterized by repetitive hair pulling leading to noticeable hair loss (criterion A),
increasing tension prior to and when resisting pulling (criterion B), a sense of gratification, relief or
pleasure when pulling (criterion C), is not better accounted for by another mental disorder or caused by a
mental condition (criterion D) and results in distress or impairment in leisure, social and/or occupational
functioning (criterion E)
Prevalence
• Assuming strict diagnostic criteria for DSM-5 (including sense of growing tension preceding hair
pulling) its prevalence is estimated at 0.6%.
• Insidence peaks occur at the age 4 and 17 years
• Trichotillomania may be more prevalent in females (it may be that males with trichotillomania are
more able to conceal hair loss resulting from pulling e.g., by shaving)
• The scalp is the most common (72.8%), followed by eyebrows (56.4%), pubic reagion (17%), chin
(10%).
Comorbidity
Individuals with trichotillomania have elevated rates of formal depressive (29.2-52%), axiety
(8.3-27%) and alcohol use (33.3%) disorders and individuals with trichotillomania acknowledge
problems with anxiety or depressed mood (66-68%).
Etiology
 High prevalence compatibility among monozygotic twins, estimated at approximately 38%,
accounts for genetic background
 Mutations in genes involved in neurodevelopmental processes or synaptic functions.
 Stress may play a role in the development of trichotillomania and that hair pulling soothes
increasing tension.
 Psychoanalytic explanations for hair pulling center on the behavior as being related to
unconscious conflicts.
 Currently used diagnostic systems (DSM-5 and ICD-10) classify trichotillomania as the impulse
control disorder – emphasising its relationship to obsessive-compulsive cluster.
How is psychiatric comorbidity in adults appear?
anxiety disorders
mood disorders
substance use disorders
eating disorders
personality disorders
What is trichobezoars?
The subset of individuals with TTM who ingest the hairs after pulling are at risk of
gastrointestinal complications stemming from trichobezoars.
In their mildest form, trichobezoars can cause heightened risk of gastrointestinal complications.
In extreme cases, trichobezoars can be fatal and often require surgical procedures for removal.
Symptom
Individuals with TTM report bald spots in a variety of body sites, including scalp, face, arms,
legs, and pubic areas. In youth TTM populations, scalp hair appears to be the most common
pulling site; however, eyebrows and eyelashes were also reported as common areas to pull.
Pulling can be both automatic (outside awareness) and focused (in response to identifiable
affective triggers).
In automatic pulling, individuals report little or no awareness of their pulling; however,
individuals who display focused pulling are fully aware of their pulling behavior and are typically
able to identify an affective trigger.
 How much this disorders affect functioning?

Emotional impairment is also prevalent in TTM populations, as guilt, shame, and low
selfesteem run common in individuals with this disorder.
Clinical Presentation and Course
 Patients rarely seek for psychological or psychiatric help spontaneously and even if they do,
they often deny the problem during a routine medical interview.
 “Warning signs”, which should draw a clinician’s attention :
 A. Loss of scalp hair or reported problems with hair loss
 B. Loss of hair in other regions of the body: eyebrows, eyelashes, pubic hair, beard, armpits,
chest, legs
 C. Sometimes – accompanying changes in glabrous skin (scrapes, wounds, inflamed areas of
the skin) – as a result of regular irritation of these areas
 D. Abnormal behaviour or appearance of the patient – including, unwarranted by other
circumstances, wearing hats, scarves, wigs, heavy eye makeup, extravagant spectacles
Laboratorium
 Histopathology characteristic of the hair follicle called tricomalasia  trichotillomania or
alopesia ?
Treatment
Psychological treatment
◦ Habit reversal therapy (subject develop an increased awareness of pulling  learn specific technique to
decrease pulling)
◦ Negative practice (subject complete the motion of pulling out hair without actually pulling out  in front of
mirror)
◦ Acceptance commitment therapy
◦ Supportive group therapy
◦ Behavior group therapy
Pharmacological treatment
◦ Clomipramine better than desipramine
◦ SSRI  not prove benefically
◦ Naltrexone
◦ Olanzapine  weigth gain (adverse effect)
◦ N Acetyl Cystein
 NIH Public Access
Curr Psychiatry Rep. 2012 June ; 14(3): 188–196.
Julie P. Harrison and Martin E. Franklin
NIH Public Access
Expert Rev Neurother. 2011 August ; 11(8): 1165–1174.
Martin E Franklin, Kathryn Zagrabbe, and Kristin L Benavides
Diagnosis and Treatment of Trichotillomania
Liana RN SCHREIBER, BRIAN l Odlaug & Jon E Grant
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, MN, USA
Neuropsychiatry (2011) 1 (2), 123-132