Trichotillomania (hair pulling disorder): Clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations

Abstract

Trichotillomania (hair pulling disorder) is a fairly common but underreported disorder characterized by recurrent episodes of pulling hair from different parts of the body. Currently classified in Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5) under the heading of the "Obsessive-compulsive spectrum and related disorders." The estimated prevalence data suggest that 0.5-2% of the general population suffers from this disorder. Stress and anxiety are directly correlated to the production of trichotillomania symptoms. The psychosocial aspects of trichotillomania are greatly underestimated, but recent literature suggests an increased interest in this neglected area. Although no FDA approved medications are available for the treatment of trichotillomania, a variety of medications including N-acetylcysteine have shown benefit in case reports. Combined liaison clinics, with an interdisciplinary approach, are highly advisable in the treatment of these cases.

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

“…5 This falls within previous prevalence estimates of 0.5% to 2.0%, but it has been noted that prevalence may be underestimated due to underreporting. 2,4 Interestingly, in this study, no difference in prevalence was seen between male and female genders. This is in contrast to some previous studies that have found a female predominance of TTM in adults, but this is the first major large-scale survey conducted with a sample more representative of the general population where sampling was done outside of a clinical setting.…”

“…2,3 With an estimated prevalence between 0.5% and 2.0% of the general population, there is a need for effective treatment options. 4 This disorder has historically been thought to have a large female predominance, but recent data have challenged this notion. 5 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.…”

Trichoscopy features of trichotillomania

“…Assessment by a child psychology unit and pharmacologic modulation of the glutamate system using N‐acetylcysteine has demonstrated to be useful in the control of compulsive behavior in some patients with trichotillomania. Moreover, although no medications are approved by the U.S. Food and Drug Administration specifically for the treatment of trichotillomania, some medications, such as clomipramine or olanzapine, may help control the symptoms …”

Trichopsychodermatology: The Psychiatric and Psychosocial Aspects of Hair Disorders

“…The treatment of disorders in the field of trichopsychodermatology focuses on the role of stress on hair loss and prioritizes the development of effective coping strategies and improvement of quality of life for patients (Franca, 2015). The treatment of disorders in the field of trichopsychodermatology focuses on the role of stress on hair loss and prioritizes the development of effective coping strategies and improvement of quality of life for patients (Franca, 2015).…”

“…Patients with hair disorders often report a low quality of life and face increased levels of depression and anxiety. The treatment of disorders in the field of trichopsychodermatology focuses on the role of stress on hair loss and prioritizes the development of effective coping strategies and improvement of quality of life for patients (Franca, 2015).…”