Mental disorder classified below psychoneurotic and connected Disorders and involves continual, irresistible urges to drag hair from the scalp, eyebrows, eyelids, and different areas of the body,

1. Trichotillomania
(hair-pulling disorder)
Shazia Khan

2. The name was created by François Henri
Hallopeau in 1889, from the Greek thrix
(meaning "hair"), along with tíllein
(meaning "to pull"), and mania (meaning
"madness").

3.  Irresistible Compulsive urge to pull out one’s
own hairs(sometimes eat) from scalp, eyebrows
or other areas of the body.
 Leaves patchy bald spots
 Leading to distress
continued

4.  Ms. JK, a 22-year-old single female, an unemployed engineering graduate
belonging to a nuclear family of middle socioeconomic status was referred
to the Psychiatry out patient department by the dermatology clinic where
she presented with complaint of alopecia. She gave history of recurrent
pulling out of her hair resulting in noticeable hair loss since the age of 8
years. She used to develop an urge and a sense of tension immediately
before pulling out the hair or when attempting to resist the behavior which
got relieved on pulling out the hair. Hair pulling was only from the scalp,
but never from any other site of the body. She always checked the roots of
the hair before discarding it. There was no history of biting or swallowing
of the hair. Due to the baldness arising due to her hair pulling, the patient
started using a scarf which she would wear throughout the day. She
developed decreased self-confidence due to her problems and started
avoiding social gatherings. She did not take up a job despite being called
for many interviews due to hesitation in facing anyone due to her growing
baldness.
Case report

5.  Often one hair at a time
 Episodes lasts for hours
 Relapse like state for days, months
or years
 Negative hair pull test
 Secretive or shameful
 Exhibit hairs of differing length, broken hairs,
new growth with tapered ends ,some broken
mid-shaft or uneven stubble
Signs and symptoms

6.  A. Recurrent pulling out of one’s hair, resulting in
hair loss.
 B. Repeated attempts to decrease or stop hair
pulling.
 C. The hair pulling causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
 D. The hair pulling or hair loss is not attributable to
another medical condition (e.g., a dermatological
condition).
 E. The hair pulling is not better explained by the
symptoms of another mental disorder (e.g., attempts
to improve a perceived defect or flaw in appearance
in body dysmorphic disorder).
Diagnostic Criteria 312.39
(F63.2)

7. Genetic
Environmental (sedentary,
during sleep)
Serotonin
Dopamine
Positive reinforcement
causes

8.  Family history (first degree relative of
OCD)
 Age (usually develops in adolescents
between age 11-13, usually lifelong
problem, children under age 5 are
prone but go away its own)
 Negative emotions (stress, anxiety,
loneliness, fatigue and frustration)
 Gender (in early childhood equally
affected but more in women than man
10:1)
Risk factors

9. Emotional distress, shame,
embarrassment and low self
esteem
Social problems( compensatory
behaviors)
Skin damage leasing infections
hairballs
consequences

10. Normative hair
removal/manipulation
Other OCD’s
Neurodevelopmental disorders
Psychotic disorders
Another medical condition
Substance related disorders
Differential diagnosis

11. MDD
Excoriation disorder
Other specified OCD’s
comorbidity

12.  Augmentation of serotonergic agents with
dopamine blockers may play a role in the
treatment of trichotillomania.
 It is a chronic condition and difficult to treat.
No formal treatment algorithm is present for
trichotillomania and no drug has been found
to be universally effective.
 Habit reversal training (HRT) adjacent with
medications
https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C3358939/
Treatment