A comprehensive PowerPoint document covering the psychiatric illness trichotillomania in different aspects including but not limited to ( definition, classification, epidemiology, comorbidity, etiology, clinical features, diagnosis, differential diagnosis, disease course, prognosis and treatment ) followed by an attached article for further reading and comprehension. Disclaimer, This is a product of pure student effort, it can have flaws, however the information listed in this document are authentic and genuine to the best of my knowledge. In case of any suggestions and comments, feel free to contact me at YazzanAlotaibi@gmail.com

1. Trichotillomania
Yazzan Mohammed Alotaibi

2. Outline
• Definition
• Classification
• Epidemiology
• Comorbidity
• Etiology
• Clinical features
• Diagnosis
• Differential Diagnosis
• Course and Prognosis
• Treatment
• Recommended Reading

3. Definition
• Hair-pulling disorder.
• Characterized by chronic hair-pulling from different areas i.e. scalp, pubic area,
eyebrow, and armpits.
• There is tension preceding the act of hair-pulling, followed by gratification.

4. Incomplete alopecia
FIGURE 10.4-1
(From Sadock BJ,
Sadock VA, Ruiz P, eds.
Kaplan & Sadock’s
Comprehensive
Textbook of Psychiatry.
9th ed. Philadelphia:
Lippincott

5. Pubic hair alopecia
FIGURE 10.4-2
(From Sadock BJ, Sadock
VA, Ruiz P, eds. Kaplan
& Sadock’s
Comprehensive Textbook
of Psychiatry. 9th ed.
Philadelphia: Lippincott

6. Classification
• Focused pulling;
- The patient is aware during the hair-pulling act.
- There is a report of an unpleasant sensation the caused them to pull their hair
( burning, tingling, or urge ).
• Automatic pulling;
- Outside of the patient awareness.
- Unintentional.
- Usually during sedentary activities.
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

7. Epidemiology
• Prevalence
- Estimated at 0.6% to 3.4% of the general population.
- Early to mid-adolescence (10 – 16 ).
- Female to male ratio 10 to 1.
- Can be underestimated because of the shame and secretiveness.
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

8. Comorbidities
• Significant comorbidity
- Obsessive-Compulsive Disorder (OCD).
- Borderline personality disorder.
- Narcissistic personality disorder.
- Tourette’s syndrome.
- Eating disorders ( trichophagia, trichobezoars, and malnutrition ).
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

9. Etiology
• Multifactorial;
- Environmental, Mother-child relationship, fear of being left alone,
substance abuse.
- Genetic, patients with family history of tics, impulse-control disorders, and
OCD.
- Biological, small left putamen and left lenticulate area, defective serotonin
receptor.
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

10. Diagnosis
• Chamberlain, Samuel & Menzies, Lara
& Sahakian, Barbara & Fineberg,
Naomi. (2007). Lifting the Veil on
Trichotillomania. The American journal
of psychiatry. 164. 568-74.
10.1176/appi.ajp.164.4.568.

11. Clinical features
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

12. Differential Diagnosis
• Obsessive-Compulsive Disorder (OCD).
• Factitious disorders ( Munchausen ).
• Alopecia areata.
• Tine capitis.
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

13. Course and prognosis
• Waxing and waning.
- Early onset (< 6 ) tend to be more responsive to suggestions and behavioral
therapy.
- Late onset ( > 13 ) tend to be less responsive and proceed to chronicity.
Kaplan and Sadock’s synopsis of psychiatry, 11th edition

14. Treatment
• Involve both dermatologist and psychiatrist.
• Pharmacologic;
- Hydroxyzine hydrochloride (Vistaril ®).
- Anti-depressants i.e. tricyclics Clomipramine.
- SSRIs.
- Lithium.
• Non-pharmacologic;
- Biofeedback.
- Self-monitoring.
- Psychotherapy.
Woods DW. Treating trichotillomania across the lifespan. J Am
Acad Child Adolesc Psychiatry. 2013;52(3):223–224.

15. Recommended Reading

16. Thank you