Causative and risk factors
The exact cause of trichotillomania is not known. It is thought to occur due to a combination of genetic and environmental factors. The condition is more commonly seen in young children and teenagers.
Trichotillomania may be associated with other disorders such as obsessive-compulsive disorder or depression.
Clinical presentation
The patient repeatedly pulls out hair from the scalp, eyelashes, eyebrows or other parts of the body. Extreme tension is felt by the patient if he/she resists the urge to pull out hair. This tension changes to a sense of relief once the hair is pulled out. Hair pulling is generally carried out in private so that others do not notice it. The process of pulling may be done voluntarily (focused activity) or automatically (without realizing). After pulling out hair, the patient may chew or eat it. The area that the hair is pulled out from appears sparse, thinned out or even bald.
Trichotillomania may be associated with chewing of lips, biting of nails and picking of skin.
Investigations
The diagnosis of trichotillomania is done on the basis of patient history and physical examination. The patient must satisfy the criteria laid down by the Diagnostic and Statistical Manual of Mental Disorders (DSM) to be diagnosed with trichotillomania. These include:
- You repeatedly pull out your hair, resulting in noticeable hair loss.
- You repeatedly try to stop pulling out your hair or try to do it less often.
- Pulling out your hair causes you significant distress or problems at work, school or in social situations.
- Your hair loss isn’t due to another medical or skin condition or the symptom of another mental disorder.
Treatment
Psychotherapy is the main form of treatment. Medications such anti-depressants or anti-psychotic drugs may be recommended.
