Trichotillomania (TTM, also known as trichotillosis,[1] or colloquially A colloquialism is a linguistic phrase that is characteristic of or only appropriate for casual, ordinary, familiar, and/or informal written or spoken conversation, rather than for formal speech, standard writing, or paralinguistics. Dictionaries often display colloquial words and phrases with the abbreviation colloq. as an identifier as trich) is defined as "hair loss from a patient's repetitive self-pulling of hair"[2] and is characterized by the repeated urge to pull out scalp hair The blood supply of the scalp is via five pairs of arteries, three from the external carotid and two from the internal carotid:, eyelashes An eyelash or simply lash is one of the hairs that grow at the edge of the eyelid. Eyelashes protect the eye from debris and perform some of the same function as whiskers do on a cat or a mouse in the sense that they are sensitive to being touched, thus providing a warning that an object is near the eye (which is then closed reflexively), facial hair, nose hair Nasal hair or nose hair is the hair in the nose. Adult humans have hairs in the anterior nasal passage. Nasal hair has important implications for the health of the human body because a lack of nasal hair could invite the transport of potentially harmful particles into the respiratory system.[citation needed], pubic hair, eyebrows The eyebrow is an area of thick, delicate hairs above the eye that follows the shape of the lower margin of the brow ridges of some[which?] mammals. Their main function is to protect the eye,[citation needed] but they are also important to human communication and facial expression. It is not uncommon for people – women in particular – to or other body hair, sometimes resulting in noticeable bald patches.[3] Trichotillomania is classified in the Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, (DSM-IV) as an impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder , kleptomania (stealing), pathological gambling, pyromania (fire-starting), and three Body-focused repetitive or compulsive behaviors of trichotillomania (a compulsion to pull one's hair out), onychophagia (compulsive nail biting) and, but there are questions about how it should be classified. It may seem, at times, to resemble a habit Habits are routines of behavior that are repeated regularly and tend to occur subconsciously, without one being conscious about them. Habitual behavior often goes unnoticed in persons exhibiting it, because a person does not need to engage in self-analysis when undertaking routine tasks. Habituation is an extremely simple form of learning, in, an addiction, a tic disorder Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic, stereotyped, involuntary movements). Tic disorders are defined similarly by the World Health Organization (ICD-10 codes) or an obsessive–compulsive disorder.
The disorder "leads to noticeable hair loss, distress, and social or functional impairment", and is "often chronic and difficult to treat".[3]
Trichotillomania may be present in infants, but the peak age of onset is 9 to 13. It may be triggered by depression or stress. Due to social implications the disorder is often unreported and it is difficult to accurately predict its prevalence In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. It is used as an estimate of how common a condition is within a population over a; the lifetime prevalence is estimated to be between 0.6% (overall) and may be as high as 1.5% (in males) to 3.4% (in females).
The name, coined by French dermatologist François Henri Hallopeau François Henri Hallopeau was a French dermatologist. He studied medicine under Alfred Vulpian and Sigismond Jaccoud. He co-founded and was secretary general of the Société Française de dermatologie et de syphiligraphie. He became a member of the Académie de Médecine in 1893, derives from the Greek: trich- (hair), till(en) (to pull), and mania Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. The word derives from the Greek "μανία" , "madness, frenzy" and that from the verb "μαίνομαι" (mainomai), "to be mad, to rage, to be ("an abnormal love for a specific object, place, or action").[4]
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Classification
Trichotillomania, "in the broadest sense ... is self-induced [recurrent] loss of hair".[2] It is classified in DSM-IV as an impulse control disorder Impulse control disorder is a set of psychiatric disorders including intermittent explosive disorder , kleptomania (stealing), pathological gambling, pyromania (fire-starting), and three Body-focused repetitive or compulsive behaviors of trichotillomania (a compulsion to pull one's hair out), onychophagia (compulsive nail biting) and with pyromania A type of impulse control disorder, pyromania is an impulse to deliberately start fires to relieve tension and typically includes feelings of gratification or relief afterward. The term pyromania comes from the Greek word pyro . Pyromania is distinct from arson, and pyromaniacs are also distinct from those who start fires because of psychosis, for, pathological gambling Problem gambling is an urge to gamble despite harmful negative consequences or a desire to stop. Problem gambling often is defined by whether harm is experienced by the gambler or others, rather than by the gambler's behavior. Severe problem gambling may be diagnosed as clinical pathological gambling if the gambler meets certain criteria. Although and kleptomania Kleptomania is an irresistible urge to steal items of trivial value. People with this disorder are compelled to steal things, generally, but not limited to, objects of little or no significant value, such as pens, paper clips, paper and tape. Some kleptomaniacs may not even be aware that they have committed the theft[dubious – discuss], and includes the criterion of an increasing sense of tension before pulling the hair and gratification or relief when pulling the hair.[3] However, some people with trichotillomania do not endorse the inclusion of "rising tension and subsequent pleasure, gratification, or relief" as part of the criteria;[3] 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".[2]
Trichotillomania has been hypothesized to lie on the obsessive–compulsive spectrum, which is proposed to encompass obsessive–compulsive disorder (OCD), nail biting and skin picking, tic disorders Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic, stereotyped, involuntary movements). Tic disorders are defined similarly by the World Health Organization (ICD-10 codes) and eating disorders Eating disorders are a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and emotional health, binge eating disorder, bulimia nervosa, anorexia nervosa being the most common specific forms in the United States, Though primarily. These conditions may share "clinical features, genetic contributions, and possibly treatment response"; however, differences between trichotillomania and OCD are present in symptoms, neural function and cognitive profile.[3] In the sense that it is "associated with irresistible urges to perform 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.[3] However, differences between the disorder and OCD have been noted including differing peak ages at onset, rates of comorbidity In medicine, comorbidity is either the presence of one or more disorders (or diseases) in addition to a primary disease or disorder, or the effect of such additional disorders or diseases, gender differences, and neural dysfunction and cognitive profile.[3] When it occurs in early childhood, it "can be regarded as a distinct clinical entity".[3]
Because trichotillomania can present in multiple age groups, it is helpful in terms of prognosis and treatment to approach three distinct subgroups by age: "preschool age children, preadolescents to young adults, and adults".[2]
Trichotillomania is often not a focused act, but rather hair pulling occurs in a "trance-like" state;[5] hence, trichotillomania is subdivided into "automatic" versus "focused" hair pulling.[2] Children are more often in the automatic, or subconscious, subtype and may not consciously remember pulling their hair. Other individuals may have focused, or conscious, rituals associated with hair pulling, including seeking specific types of hairs to pull, pulling until the hair feels "just right", or pulling in response to a specific sensation.[2] Knowledge of the subtype is helpful in determining treatment strategies.[2]
Signs and symptoms
Trichotillomania is usually "confined to one or two sites",[3] but can involve multiple sites: "the scalp is the most common, then eyebrows, eyelashes, face, arms, legs, and pubic hairs".[2] The classic presentation is the "Friar Tuck" form of vertex and crown alopecia.[6] Children are less likely to pull from areas other than the scalp.[2]
Individuals with trichotillomania exhibit hair of differing lengths; some are broken hairs with blunt ends, some new 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 pull test is negative (the "hair does not pull out easily"). Hair is often pulled out leaving an unusual shape; individuals with trichotillomania may be secretive or shameful of the hair pulling behavior.[2]
An additional psychological effect can be low self-esteem Self-esteem is a term used in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame. Self-esteem can apply specifically to a particular dimension (for example, "I believe I am a good writer, and feel proud of that in, often associated with being shunned by peers and the fear of socializing due to appearance and negative attention they may receive. Some people with TTM wear hats, wigs, wear false eyelashes, eyebrow pencil, or style their hair in an effort to avoid such attention. There seems to be a strong stress Stress is a term in psychology and biology, first coined in the 1930s, which has in more recent decades become a commonplace of popular parlance. It refers to the consequence of the failure of an organism – human or animal – to respond appropriately to emotional or physical threats, whether actual or imagined-related component. In low-stress environments, some exhibit no symptoms (known as "pulling") whatsoever. This "pulling" often resumes upon leaving this environment.[7] Some individuals with TTM may feel they are the only person with this problem due to low rates of reporting.[8]
Other medical complications include "infection, permanent loss of hair, repetitive stress injury Repetitive strain injury (also known as repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CT), occupational overuse syndrome, overuse syndrome, regional musculoskeletal disorder) is an injury of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful, carpal tunnel syndrome Carpal Tunnel Syndrome , is associated by symptoms and signs, which are caused by compression of the median nerve travelling through the carpal tunnel. Carpal Tunnel Syndrome affects the hands since it is an upper limb neuropathy that results in motor and sensory disturbance of the median nerve, and gastrointestinal obstruction ... as a result of trichophagia Trichophagia is the compulsive eating of hair. Most often, long hair is masticated (chewed) while still attached to the head and then swallowed. The hair eventually collects in the gastrointestinal tract causing symptoms such as indigestion and stomach pain. A purgative can be given to induce the elimination of the resulting trichobezoar".[3] In trichophagia, people with trichotillomania also ingest the hair that they pull; in extreme (and rare) cases this can lead to a hair ball (trichobezoar).[2] Rapunzel syndrome The Rapunzel syndrome is an extremely rare intestinal condition in humans resulting from eating hair . The syndrome is named after the long-haired girl Rapunzel in the fairy tale by the Brothers Grimm. Trichophagia is sometimes associated with the hair pulling disorder trichotillomania, an extreme form of trichobezoar in which the "tail" of the hair ball extends into the intestines, can be fatal if misdiagnosed.[2][9][10][11]
Environment is a large factor which affects hair pulling.[5] Sedentary activities such as being in a relaxed environment are conducive to hair pulling.[5][12] A common example of a sedentary activity promoting hair pulling is lying in a bed while trying to rest or fall asleep.[5] An extreme example of automatic TTM is found when some patients have been observed to pull their hair out while asleep.[5] This is called sleep-isolated trichotillomania.[13]
Causes and pathophysiology
Anxiety Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, apprehension, fear, or worry. Anxiety is a generalized mood condition that can often occur without an identifiable, depression Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. The term "major depressive disorder" was selected by the American Psychiatric Association to designate this symptom cluster as a mood disorder and obsessive–compulsive disorder are more frequently encountered in people with TTM.[3][14] Trichotillomania has a high overlap with post traumatic stress disorder Posttraumatic stress disorder is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma. This event may involve the threat of death to oneself or to someone else, or to one's own or someone else's physical, sexual, or psychological integrity, overwhelming the individual's ability to cope. As an, and some cases of trichotillomania may be triggered by stress. "Another school of thought emphasizes hair pulling as addictive or positively reinforcing insofar as it is associated with rising tension beforehand and relief afterward."[3] A neurocognitive model—"the notion that the basal ganglia The basal ganglia are a group of nuclei in the brains of vertebrates, situated at the base of the forebrain and strongly connected with the cerebral cortex, thalamus and other areas. The basal ganglia are associated with a variety of functions, including motor control and learning. Currently popular theories implicate the basal ganglia primarily play[s] a role in habit formation and that the frontal lobes The frontal lobe is an area in the brain of mammals. It is located at the front of each cerebral hemisphere and positioned anterior to the parietal lobes and above and anterior to the temporal lobes. It is separated from the parietal lobe by the primary motor cortex, which controls voluntary movements of specific body parts associated with the are critical for normally suppressing or inhibiting such habits"—sees trichotillomania as a habit disorder.[3]
Abnormalities in the caudate nucleus The caudate nucleus is a nucleus located within the basal ganglia of the brains of many animal species. The caudate nucleus is an important part of the brain's learning and memory system are noted in OCD, but there is "no evidence to support the existence of volumetric caudate abnormalities in ... trichotillomania".[3] One study showed that individuals with TTM have decreased cerebellar The cerebellum is a region of the brain that plays an important role in motor control. It is also involved in some cognitive functions such as attention and language, and probably in some emotional functions such as regulating fear and pleasure responses, but it is its function in movement that is most clearly understood. The cerebellum does not volume.[3][15] These findings suggest some differences between OCD and trichotillomania.[3] There is a lack of structural MRI Magnetic resonance imaging , or nuclear magnetic resonance imaging (NMRI), is primarily a noninvasive medical imaging technique used in radiology to visualize detailed internal structure and limited function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it studies on trichotillomania.[3]
It is likely that multiple genes confer vulnerability to trichotillomania.[3] One study identified mutations in the SLITRK1 gene,[3][16] another identified differences in the serotonin 2A receptor genes The mammalian 5-HT2A receptor is a subtype of the 5-HT2 receptor that belongs to the serotonin receptor family and is a G protein-coupled receptor . This is the main excitatory receptor subtype among the GPCRs for serotonin (5-HT), although 5-HT2A may also have an inhibitory effect[citation needed] on certain areas such as the visual cortex and,[3][17] and mice with a mutation on the HOXB8 gene showed abnormal behaviors including hair pulling. These data are preliminary, but could indicate a genetic component in trichotillomania.[3][18]
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Fri, 28 May 2010 13:14:23 GMT+00:00
BusinessWeek When the procedure was performed in reverse, normal mice injected with abnormal Hoxb8 developed trichotillomania . The experiment also showed that a high ... Bone marrow transplants could cure mental illnesses Gossip Jackal Rebuilt immune system shakes off OCD New Scientist Nobel winner links mental illness to immune system defect Sify Science Now - KUER - Los Angeles Times (blog)
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A jumbo blunt
tlctrichster
hu, 01 Jul 2010 17:17:33 GM
Good morning world! Sometimes, I just wonder who I am writing to. How did you get to this blog, what is your life story, are we neighbors but don't know it? So very interesting. Today, I want to share something about my personal process ...
