February 14, 2008

Thursday, February 14, 2008
The following is a snippet of a recent paper that I have written regarding a disorder that seriously lacks attention:

“Late at night, I sit at the end of the sofa, pull the shade off the lamp and allow the bright light to expose hundreds of beautiful hairs. My focus is intense and with great concentration, I locate very fine hairs and pluck them. This gives me great pleasure and the sharp pain relaxes me. The concentration takes me away. I love releasing the once buried little hairs and pulling them. With great luck, I find the thick hairs, some with their black sac still attached. I save those hairs like trophies carefully laying them along the arm of the sofa, black against white. […] now I go to bed exhausted but satisfied.” (Penzel, 2003, p. 10)

This scenario depicts the experience of some sufferers of trichotillomania. The term can be traced back to 1889 when it was first defined by French physician Halipeau (Long, Miltenberger & Rapp, 2006, p. 133). The term itself is Greek in origin; trich refers to hair, tillo refers to pull, and mania refers to madness (Penzel, 2003, p. 2). There is a tendency for this disorder to be more common among females and to develop in childhood or early adolescence (Long et al., 2006, p. 137). Trichotillomania is also commonly associated with other disorders such as mood or anxiety (Long et al., 2006, p. 138). Common areas of pulling are the scalp, eyebrows, eyelashes, face, limbs, and pubic area (Penzel, 2003, p. 8). The physical and emotional costs of this disorder can be debilitating. A number of physical consequences may include calluses on finger tips, strain injuries such as in the neck and back, infections such as on the eyelids and pubic area, and the development of gastrointestinal problems from the swallowing of hair or what is called trichophagy (Penzel, 2003, p. 4). Subsequently, “feelings of shame, helplessness, isolation, and frustration can take a tremendous toll on sufferers” (Penzel, 2003, p. 5). Although, it is estimated to affect roughly 2.5 million people in the United States, the actual rate of occurrence is often inaccurate due to misdiagnoses and extraordinary attempts at disguising or concealing the disorder (Kelly, McCormick & White Kress, 2004, p. 2). The fourth edition of The Diagnostic and Statistical Manual of Mental Disorders currently groups trichotillomania with other Axis I impulse control disorders such as pyromania and kleptomania and is defined by the following criterion:

A. Recurrent pulling out of one’s hair resulting in noticeable hair loss.
B. Feeling of tension immediately before pulling hair out or when attempting to pull hair out.
C. Sense of pleasure, gratification, or relief when pulling out hair.
D. Hair pulling is not better explained by the presence of some other disorder.
E. Hair pulling causes significant distress and an impairment of the ability to function in an important area of one’s life. (Penzel, 2003, p. 2)

The assessment of trichotillomania is conducted through several non-standard and standard measures. The initial interview establishes the baseline and allows the clinician to gather a complete picture of the presenting behaviour and its effect on the individual’s life. Standardized tests help to assess the severity of the disorder; however there is an obvious deficiency in strong assessment measures and Breckenridge et al. (1999) suggest that this is in part due to the scales’ context (p. 168). Results from various studies suggest that a multi-method approach is most effective when assessing trichotillomania. “An ideal TM measure would include homogeneous subscales that measure situational variables, affective states, and sensory stimuli associated with hair pulling behaviour in addition to frequency, duration, and interference of symptoms” (Breckenridge et al., 1999, p. 168). To date, trichotillomania lacks answers to such questions as whether the disorder is conceptually related to OCD or more similar to other disorders such as skin picking (Penzel, 2000, p. 1). The controversy with respect to etiology has an extensive impact on assessment methods and tools. Inevitably, assessment influences treatment and treatment affects outcome, so this begs the question: are trichotillomaniacs obtaining appropriate benefits from current methods?

© www.mentalhealthblog.com

, , , , , , , ,

10 comments

10 comments:

Swahilya said...

oops! Scary such diorders. Will come more to your blog.

meg said...

Thanks for your comment. Please do stop by again :)

Untreatable said...

this is the part that has always caused some confusion with me what is the difference between this disorder and self harm or is there one. I have always seen it as a subcategory as self harm so the suggestions I give are very similar to someone who cuts for example

meg said...

From the research I've been conducting it seems that no one knows how to approach this one. Assessment is all over the map because there is no real consensus regarding cause. The DSM IV classifies it as an impulse control disorder, but that seems debatable.

With this in mind, the problem I foresee is whether existing treatments even make sense if there is so little agreement. My next paper is focusing on that aspect so I'll post more eventually.

Thanks for your comments :)

Anonymous said...

I must say it is a relief to see that others have this. I have been picking my eyelashes since I was about 10 and moved to my eyebrows when I was about 13. I am almost 20 now and still continue to pick my eyelashes and eyebrows daily. I usually don’t even let them grow in a little. I cover them up daily with eyeliner and as much as it’s become a pain, it’s become a part of my life. I have accepted it and often it doesn’t affect me. Not many people even notice that I have no eyelashes and eyebrows. I have become pro at applying makeup =P but I really want to let this habit go. I have always wanted my lush beautiful Italian lashes back. I was called maybelline when I was younger and I want that nickname back. I went through a stage where I would where fake eyelashes but it was a pain and they would always fall off. More people actually noticed my condition when I was trying to cover it up with fake eyelashes. It affected me more when I was younger but now it’s just apart of me. I want to let it go and I really think I have it in me to do so. But I have tried absolutely everything and I’ve always gone back to picking them. I have thought about getting hypnotized. I hear it works for some people to quit smoking. But I don’t know, it’s just a thought. Is it worth a shot?
email me at danyelian123@yahoo.com

meg said...

hi, I have read that hypnosis can be helpful for some people. It seems like treatment really depends on what works best for you. You can read a bit about what I've come across regarding treatment here: http://www.mentalhealthblog.com/2008/04/treating-trichotillomania.html

Hope everything works out for you :)

Anonymous said...

In response to Untreatable's comment, I am 32 years old and starting pulling when I was probably 7 or 8. I actually was also a cutter from the ages of 14 to 16, and have resorted to cutting 2ce in my adult life under extreme emotional stress. Before I knew there was such a thing as trich, I assumed these 2 behaviors were related. Though the pulling is not always directly related to stress, both behaviors are associated with relief through pain. Also, as an adult, I resorted to getting tattoos instead of cutting as it was obviously more socially acceptable and did not require an explanation for a scar.

meg said...

Thanks for your input!

zebe912 said...

Definitely visit www.trich.org for more information. They are at the forefront of the research on TTM. Because many pullers pull with little or no awareness that is part of why its not considered self-mutilation. TTM seems to come in many forms.

meg said...

Hi zebe912, thanks for your comment. There is no email to respond to your other question. Please send me an email if you like.

Popular Posts

Dentalget.com is dental equipment supplier, we provide high quality dental instruments, dental handpiece at a discount price. Free shipping worldwide.

About Me

I have an educational background is in Psychology and Sociology. In addition, I have worked with many diverse individuals of all ages, with varying degrees of mental and/or physical illness. I enjoy following current news and research that impacts my area of expertise.

Categories

9/11 AADD Abortion Academic Success Acetylcholine ADD Adderall Addiction ADHD Adult Attention Deficit Disorder Adultery Advertising Aggression Aging Agreeableness AIDS Air Pressure Alcohol Alcohol Abuse Alcohol Dependence Alcoholism alpha-CaM kinase II Altitude Alzheimer's Amphetamine Amygdala Amyloid Amyloid Deposition Anesthesia Anger Anterior Cingulate Cortex Anterograde Amnesia Anti-Depressants Anti-Psychotic Anticholinergic Anticonvulsant Antiepileptic Antioxidants Anxiety Anxious-Avoidant Anxious-Preoccupied Apolipoprotein E Army Aromatherapy Asperger Syndrome Assessment Associative Learning Asthma Attachment Theory Attention Attention Deficit Disorder Attention Deficit Hyperactivity Disorder Autism Autism Spectrum Disorder Autonomic Nervous System Average Sleep Requirements B-type Natriuretic Peptide Babies Balance Behavioral Problems Behaviour Behavioural Impairment Behavioural Therapy Benadryl Bipolar Disorder Blood Clot Blood Pressure Blue Light Blue Light Goggles Body Mass Index Bone Marrow Brain Brain Development Brain Imaging Brain Injury Brain Stem Brain Surgery Breast Cancer Buddhism bullying Bupropion Business C-reactive Protein Calories CAMH Canada Canadian Charter of Rights and Freedoms Cancer Carbohydrates Cardiovascular Disease Care Facilities Caregiver cars Cdk5 Cell Phone Central Nervous System Centre for Addiction and Mental Health Cerebellum Cerebral Amyloid Angiopathy Cerebral Cortex Cerebrospinal Fluid Cerebrovascular Accident Cerebrovascular Insult Chat Rooms Chewing Childhood Disabilities Childhood Disintegrative Disorder Childhood Emotional Neglect Children Chitin Chitosan Cholesterol Choline Chromosome Chronic Pain Syndrome Chronic Stress Circadian Rhythm Cirrhosis Citalopram Classical Conditioning Climate Change Clot-Busting Drug Co-morbidity Cocaine Cognition Cognitive Development Cognitive Impairment Colloquially Brain Attack Coma Communication Device Communication Technology Concentration Concerta Concussion Conflict Confusion Conscientiousness Control Group Coordination Correlation Cortisol Counselling Couples CPAP Crack CRASH-2 CRASH-3 Creativity Criminal Code Cyberbullying Cyberpsychology Cyklokapron Daytrana Death Death Toll Decision-Making Declarative Memory Deep Brain Stimulation Delusion Dementia Dentures Depression Destrostat Deviant Behaviour Dexedrine Dextromethorphan Diabetes Diet Dietary Supplements Diphenhydramine Disability discrimination Dismissive-Avoidant Disorganized Attachment Disorganized Speech Disorientation Dizziness Docosahexaenoic Acid (DHA) Double-Blind Dream Drinking Drowsiness Drug Abuse Drug Dependence Drug Use Drugs DSM DSM-5 Dual Diagnosis Early Onset Alzheimer's Economic Crisis Ecstasy Effexor Ego Eicosapentaenoic Acid (EPA) Elderly Electrical Stimulation Electroconvulsive Therapy Electrodes Email Embitterment Embolic Emotion Emotional Neglect Emotional Problems Emotional Well-Being Employee Enrivonment Enzyme Epilepsy Estrogen Ethics Evolution Experimental Group Extracellular Signal-Regulated Kinase (ERK) Extroversion Facebook Facebook Fan Page Facebook Friends Family Family Therapy Fast Food Father Father Absenteeism Fatherhood FDA Fear Fearful-Avoidant FeelingBetterNow Fetus Fibrin Fish Oil fluoxetine fMRI Focalin Focus Food Fraud Friday Gamma Secretase Genetic Disorders Genetics Ginkgo Biloba Glucose Glutamate Receptor God Gout Guest Blogger Hair Pulling Haiti Hallucination Hallucinogenic Halo Effect Harm-Reduction Headache Healthy Eating Hearing Heart Attack Heart Disease Hematopoietic Stem Cells Hepatitis Hepatitis C Herbal Supplements Hereditary Angioedema Heredity Heroin High Blood Pressure Hippocampus Hockey Homelessness Hormone Housing Hox Genes Hoxb8 Cells Human Rights Hydromorphone Hyper-social Networker Hyperactivity Hypothalamus Illness Impulse Control Impulsivity Inattentiveness Infant Infidelity Inflammation Insecure Attachment Insomnia Instant Messaging Insulin Intellectual Development Intellectual Disability Internet Intracranial Bleeding Introversion Introvert Ischemic Stroke KASPAR Ketamine Ketogenic Kleptomania Laptop Latent Inhibition Learning Learning Disability Leukotrienes Limbic System Lithium Liver Locked-In Syndrome Long Term Memory Long-Term Potentiation Longevity Lupus Lysteda Maestro Rechargeable System Major Depression Mania MAOI Marriage MDMA Medication Meditation Melatonin Memory Memory Loss Memory Task Men Mental Health Mental Health Forum Mental Heath Mental Illness Metadate Metyrapone Mice Microglia Mild Cognitive Impairment (MCI) Mild Traumatic Brain Injury Military Mind-Body Mindless Eating Mitochondria MOHLTC Mood Disorder Morphine Mortality Rates MRI MS-275 Multiple Sclerosis Muscle Weakness music therapy Narcissism Natasha Richardson National Sleep Foundation Natural Disaster Nature/Nurture Nausea Necrosis Neglect Nerve Neuro-imaging Neurobiology Neurodegeneration Neurodegenrative Diseases Neurodevelopment Disorders Neurogenesis Neurological Disease Neuromarketing Neuron Neuropathy Neuroticism Neurotransmitter News Nintendo Wii Non-REM Sleep Nose Nurse Ratched Nutrition Obesity Obessive Compulsive Spectrum Disorder (OCD) Offspring Olfactory Gland OM3 Emotional Balance Omega 3 Ontario Ontario Review Board Ontario Works Opioid Oral Health Organic Ottawa Over-activity Over-Medication Ovulation Oxidative Cell Oxygen Oxytocin p35 Pacemaker Pain Pain Killer Pain Management Pancreatic Polypeptide Pancreatitis Paralysis Paranoia Paraskevidekatriaphobia Parenthood Parents Parkinson's Paroxetine Paxil PDD-NOS perception Perfume Peripheral Nervous System Peroxisome Proliferator-Activated Receptor Gamma (PPARγ) Pathway personality traits Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) PET Scan Pharmacology Phobias Physical Health Physiological Plasmin Plasminogen Plasticity Platelet-Activating Factor Politics Post-Concussion Assessment and Cognitive Test (ImPACT) Potassium Ion Channel Poverty Pregnancy Pressure Procedural Memory Promiscuity Prozac PsychBoard.com Psychiatric Ward Psychological Psychological Inventories Psychologist Psychology Psychology Forum Psychology of Eating Psychosis PTED PTSD Public Health Pyromania Quadriplegic Rehab Relationships Reliability Religion REM Research Retigabine Retrograde Amnesia Rett Syndrome Risperdal Ritalin road rage Robot Robotics Rodent Research Rosiglitazone Samsung Satiety Scales Schizophrenia School Screening Secure Attachment Sedatives Seizure Self-Affirmation Intervention Self-Confidence Self-Esteem Self-Integrity Self-Worth Semantic Memory Senior Seroquel Serotonin Serzone Sex Sex Therapy Sexual Orientation Sexual Satisfaction Shock Therapy Sideline Concussion Assessment Test (SCAT2) Sleep Sleep Apnea Sleep Disorders Sleep Quality Sleep Stages Smartphone Smoking Snacking Sniffing Technology Social Assistance Social Deficits Social Isolation Social Media Social Network Social Rejection Social Skills Social Worker Socialization Societal Change Soft Palate Soldier Somatic Nervous System Spatial Memory Special K Speech Spinal Cord Spinal Cord Injury Spinal Tap Sports Injury SSRI Statin Stem Cell Stimulant Strattera Stress Stress Hormone Stroke Substance Abuse Sugar Suicide Superstition Support Survey Suspicious Tablet Talk Therapy Tamoxifen Tanorexia Tax Payer Technology Television Telomere Temperature Testosterone Texting Therapy Thorazine Threshold Thrombosis Thrombotic Tinnitus Tissue Plasminogen Activator Topographical Disorientation Tranexamic Acid Trauma Treatment Tremors Trial Tribunal Trichotillomania Type-2 Diabetes Vagus Nerve Validity Ventromedial Prefrontal Cortex Video Games Virtual Reality Vision Visual Attention Vitamin B Vitamins Vitiligo Voice Vyvanse Walnuts Weight Loss Welfare Wellbutrin Wernicke–Korsakoff syndrome Wet Brain White Blood Cells Women Work World Health Organization Zileuton Zyban Zyprexa µ-opiate receptors (MOR)