CD-ROM Today (UK) (Spanish) 15/CDRT.iso/dp/0428/04286.txt

Text File | 1994-01-18 | 8.8 KB | 208 lines

$Unique_ID{BRK04286}
$Pretitle{}
$Title{Trichotillomania}
$Subject{Trichotillomania Hair pulling Obsessive Compulsive Disorder}
$Volume{}
$Log{}

Copyright (C) 1990 National Organization for Rare Disorders, Inc.

768:
Trichotillomania

** IMPORTANT **
It is possible that the main title of the article (Trichotillomania) is
not the name you expected.  Please check the SYNONYM listing to find the
alternate names and disorder subdivisions covered by this article.

Synonyms

     Hair pulling

Information on the following diseases can be found in the Related
Disorders section of this report:

     Obsessive Compulsive Disorder

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Trichotillomania is a mental illness characterized by an overwhelming and
irresistible impulse to pull out one's own hair.  This results in patches of
baldness, usually on the most easily accessible areas such as the scalp,
eyebrows, eyelashes or beard.  Mouthing of the hair (trichophagy) commonly
follows the hair pulling.  Trichotillomania is classified as a disorder of
impulse control.

Symptoms

The principle symptom of Trichotillomania is the recurrent failure to resist
impulses to pull out one's own hair.  An individual with this disorder
usually feels extremely tense immediately before pulling out the hair.  The
act of hair pulling usually results in a sense of release from this tension.
Hairs may be broken off or pulled out.  Patches of baldness usually result on
the scalp.  Other areas commonly involved are the eyebrows, eyelashes, and
beard.  Hair from the trunk, armpits and pubic area is less commonly pulled
out.

Other symptoms of Trichotillomania include the appearance of short,
broken strands of hair together with long, normal hairs in the affected
areas.  There is usually no scarring of the surface of the scalp.  There may
be a generalized itching or tingling in the involved areas, but pain does not
routinely follow the hair plucking.

Individuals with Trichotillomania usually deny that the hair-pulling
behavior exists, and often take great strides to conceal or camouflage the
resultant baldness.  Affected individuals may wear wigs and false eyelashes.
When an affected individual exhibits unexplained baldness, a scalp biopsy
will usually uncover the traumatic source.  Plugs of fibrous protein
(keratin) are found present in the scalp along with an absence of
inflammation or scarring.  There are usually characteristic changes in the
structure of the hair follicle (trichomalacia).

People with Trichotillomania may also have symptoms of head-banging,
nail-biting, scratching, gnawing, abrading or wearing off of the skin
(excoriation) and other acts of self-mutilation.  Children with
Trichotillomania commonly suck their fingers.  The disorder has been known to
persist for two decades in some individuals.  Approximately one-third of
reported cases claim a duration of one year or less.  Frequent periods of
worsening symptoms and remissions are common.

Causes

The exact cause of Trichotillomania is not known.  Approximately one-quarter
of the reported cases have been linked to stressful situations such as
disturbances in mother-child relationships, fear of being left alone and
recent loss of a loved one.  Psychoactive substance abuse may also contribute
to the development of this disorder.  Some scientists believe that
Trichotillomania is a subcategory of Obsessive Compulsive Disorder (OCD)
which may be caused by certain imbalances in brain chemicals (see OCD in
related disorders section).  When the onset of Trichotillomania occurs in
adulthood, it commonly accompanies a psychotic disorder.

Affected Population

Trichotillomania usually occurs in childhood but cases have been reported
with an onset as late as 62 years.  The disorder is more common in
individuals with Mental Retardation, Schizophrenia, Obsessive Compulsive
Disorder or Borderline Personality Disorder.  Eldest and only children are
most often afflicted.  Trichotillomania occurs more frequently in women.
Some physicians estimate that Obsessive Compulsive Disorders such as
Trichotillomania may affect as many as eight million Americans.  However,
epidemiological studies have never been conducted so it is impossible to
estimate how many people without mental retardation are affected, and how
many of those have Trichotillomania alone instead of other OCD symptoms (such
as repeated hand washing).

Related Disorders

Symptoms of the following disorder can be similar to those of
Trichotillomania.  Comparisons may be useful for a differential diagnosis:

Obsessive Compulsive Disorder is characterized by recurrent obsessive and
compulsive thoughts and actions.  Obsessions are persistent ideas, thoughts,
impulses or images that the patient knows are senseless.  Attempts are made
to ignore or suppress such thoughts or impulses, or to counteract them with
some other thought or action.  The individual recognizes that the obsessions
are the product of his or her own mind, but they are difficult to resist.
Many scientists believe that Trichotillomania and Obsessive Compulsive
Disorder are caused by related brain chemical abnormalities because they are
often responsive to the same drug treatments.  (For more information on this
disorder, choose "Obsessive Compulsive" as your search term in the Rare
Disease Database).

Therapies:  Standard

Medications which are used in treating Trichotillomania include
chlorpromazine, isocarboxazid, amitriptyline and imipramine.  Psychoanalysis,
intensive psychotherapy, and behavior-modification therapy may be helpful in
some cases.

Therapies:  Investigational

The drug clomipramine, an antidepressant, is an FDA approved treatment for
Obsessive Compulsive disease that is being investigated as a treatment for
Trichotillomania.  Clomipramine works by enhancing the action of brain
serotonin (one of the chemicals that transmits messages between nerve cells).
The drug is manufactured by Ciba-Geigy.

The National Institutes of Health (NIH) is looking for males from ages 6-
60 for a study on Trichotillomania.  If persons of this age group want to get
information concerning the study on the compulsion to pull out hair on their
head, eyelashes, eyebrows, or any other place on their body, call Marge
Lenane at [phone] for information about this drug study being carried
out by the National Institutes of Mental Health.

This disease entry is based upon medical information available through
July 1990.  Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.

Resources

For more information on Trichotillomania, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT 06812-1783
     [phone]

     Obsessive-Compulsive Disorder Foundation
     P.O. Box 60
     Vernon, CT 06066
     [phone]

     National Mental Health Association
     1021 Prince Street
     Alexandria, VA 22314

     National Alliance for the Mentally Ill
     1901 N. Fort Meyer Dr., Suite 500
     Arlington, VA  22209
     [phone]

     National Mental Health Consumer Self-Help Clearinghouse
     311 S. Juniper St., Rm. 902
     Philadelphia, PA  19107
     [phone]

     NIH/National Institute of Mental Health (NIMH)
     9000 Rockville Pike
     Bethesda, MD 20205
     [phone] or [phone]
     [phone] (24 hrs.)

     Dr. Wayne Goodman
     Clinical Neuroscience Research Unit
     Yale School of Medicine
     CT Mental Health Center
     34 Park Street, 3rd Floor
     New Haven, CT 06508
     [phone]

References

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, 3d.:  R.L. Spitzer,
et al., eds;  American Psychiatric Association, 1984.  Pp. 326-328.

THE MERCK MANUAL, Volume 1, 14th Ed.:  Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982.  Pp. 2281.

RETURN OF SYMPTOMS AFTER DISCONTINUATION OF CLOMIPRAMINE IN PATIENTS WITH
OBSESSIVE COMPULSIVE DISORDER.  M.T. Pato et al.; AM J Psychiatry (December,
1988:  issue 145 (12)).  Pp. 1521-1525.

TRICOTILLOMANIA.  S.A. Muller; DERMATOL CLIN (July, 1987:  issue 5 (3)).
Pp. 595-601.

TRICHOTILLOMANIA IN CHILDHOOD.  A.P. Oranje et al.; J AM ACAD DERMATOL
(October, 1986:  issue 15 (4 Pt. 1)).  Pp. 614-619.