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?

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Swahilya Shambhavi said...

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

meg said...

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

Unknown 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.

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