ocd disorders, dsm 5,

1. Trichotillomania and Excoriation Disorder

2. Trichotillomania
• Trichotillomania also referred
to as “hair-pulling disorder,”
is a mental disorder classified
under Obsessive-Compulsive
and Related Disorders
• It involves recurrent,
irresistible urges to pull hair
from the scalp, eyebrows,
eyelids, and other areas of the
body.

3. Trichotillomania • Hair pulling from the face can result in
complete or partial removal of the
eyebrows and eyelashes.
• while hair pulling from the scalp can
result in varying degrees of patches of
hair loss.

4. DSM 5 Criteria
A. Recurrent pulling out one’s
hair, resulting in hair loss.
B. Repeated attempts to
decrease or stop the hair
pulling.
C. The hair pulling causes
clinically significant distress or
impairment in areas of
occupational, social or other
important areas of functioning.
D. The hair pulling or hair loss
is not attributable to another
medical condition like
dermatological condition.
E. The hair pulling is not better
explained by the symptom of
another mental disorder.

5. Associated features
• Focused. Some people pull their hair intentionally to relieve tension or distress for
example, pulling hair out to get relief from the overwhelming urge to pull hair.
• Some people may develop elaborate rituals for pulling hair, such as finding just the
right hair or biting pulled hairs.
• Automatic. Some people pull their hair without even realizing they're doing it, such
as when they're bored, reading or watching TV.
• The same person may do both focused and automatic hair pulling, depending on the
situation and mood.
• Certain positions or rituals may trigger hair pulling, such as resting your head on
your hand or brushing your hair.

6. Association with emotions
Negative emotions. For many people with trichotillomania,
hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension,
boredom, loneliness, fatigue or frustration.
Positive feelings. People with trichotillomania often find that
pulling out hair feels satisfying and provides a measure of
relief. As a result, they continue to pull their hair to maintain
these positive feelings.

7. Prevalence
Ingeneral populationtheprevalence rate for trichotillomaniain
adultsandadolescentsis1-2%,withafemale tomaleratio of10:1.
Amongchildren,femalesandmalesare more equallyrepresented.
The onsetof hairpullingmost oftencoincideswithor follows,the
onsetofpuberty.

8. Risk Factors
•Age. Trichotillomania usually
starts in the early teens,
10-13. It can last throughout
though symptoms may come
•Genes. In some families, the
tendency to trichotillomania
passed on. It’s more likely if
family member has it.

9. Risk Factors
Other mental health disorders. If you
live with trichotillomania, you may
have other mental health problems,
such as anxiety, depression, or
obsessive-compulsive disorder (OCD).
Stress. Extreme stress may trigger
trichotillomania in some people.
Stress can be triggered by situations
including family conflict, abuse, or the
death of a friend or family member.

10. Differential
Diagnosis
• Other obsessive-compulsive disorders may
share features of trichotillomania, with
sufferers of OCD sometimes pulling hairs to
create a symmetrical appearance.
• Likewise, those with body dysmorphic
disorder may remove hair that they think is
ugly. In neither case is the diagnosis
trichotillomania.
• Some psychotic disorders may incite
sufferers to remove hair during delusions or
hallucinations.

11. Differential
Diagnosis
• while substance abuse of stimulants, for
example - may also make individuals more
prone to pulling hair.
• Other neurodevelopmental disorders may
feature hair pulling as a stereotypy.
• Hair pulling and loss may also be attributed
to another medical condition, such as
dermatological disorders, alopecia and
folliculitis decalvans.
• In these instances, a skin biopsy may be
carried out to ensure correct diagnosis.

12. Trichotillomania Complications
Problems at work and in social settings. People with trichotillomania may
shy away from social situations and friendships and even turn down job
offers because they’re embarrassed about pulling.
Skin and hair damage. Constant tugging can leave scars on the scalp and
affect hair growth long-term.
Hairballs. These are large, matted wads of hair called trichobezoars that
form in the GI tract. Over time, they can cause weight loss and blockages.

13. Excoriation Disorder
• Excoriation Disorder, also known as
skin picking disorder or
dermatillomania, is characterized by
the repetitive picking of one’s own
skin.
• Individuals who struggle with this
disorder touch, rub, scratch, pick at, or
dig into their skin in an attempt to
improve perceived imperfections.
• Often resulting in tissue damage,
discoloration, or scarring.

14. Excoriation Disorder
• Skin picking disorder is one of a
group of behaviors known as body-
focused repetitive behaviors
(BFRBs).
• Self-grooming behaviors
in which individuals pull, pick,
scrape, or bite their own hair, skin,
or nails, resulting in damage to the
body.

15. DSM V Criteria
A. Recurrent skin picking resulting in skin lesions.
B. Repeated attempts to decrease or stop skin
picking.
C. The skin picking causes clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
D. The skin picking is not attributable to the physiological
effects of a substance (e.g., cocaine) or another medical
condition (e.g., scabies).
E. The skin picking is not better explained by
symptoms of another mental disorder.

16. Prevalence
An estimated 2–5% of the
population has excoriation
disorder
Excoriation is most common
among kids between the ages
of 13–15 years old but can
also affect younger children
and adults ages 30–45
Excoriation can be present in
males and females, but it
is more common in females

17. Commonly
affected
Body Areas
Hands: The presence of hangnails and skin abrasions
makes skin picking on the hands an easily accessed point of
focus for people with excoriation.
Arms: Skin picking on the arms accounts for 20% of those
with the condition
Face: An estimated 32% of people pick at the skin of their
face
Legs: Approximately 17% of people with excoriation disorder
focus most of their picking on their legs
Scalp: For 22% of those with skin picking disorder, the focus
is on the scalp

18. Risk Factors
• After some kind of rash, skin infection,
or small injury.
• People may pick at the scab or rash,
which causes more injury to the skin
and keeps the wound from healing.
• More itching leads to more picking and
more scabbing, and the cycle continues.
• Stress or anxiety
• Negative emotions, such as guilt or
shame

19. Differential Diagnosis
Psychotic disorder
Other obsessive
compulsive and related
disorders
Neurodevelopmental
disorders
Somatic symptom and
related disorders
Other medical
conditions
Substancesmedication
induced disorders

20. Comorbidity
Excoriation disorder often co-occurs with
obsessive-compulsive disorder,
trichotillomania (hair-pulling), and major
depressive disorder.
One study indicates that 38% of individuals
with excoriation disorder have co-occurring
trichotillomania.
Other body-focused repetitive behaviors
(BFRBs), such as nail biting, may also coincide
with excoriation.

21. Medication
Most recommend medication for
trichotillomania are
antidepressant, such as
clomipramine (Anafranil).
• Other medications include N-
acetylcysteine, an amino acid that
influences neurotransmitters
related to mood, and olanzapine
(Zyprexa), an atypical
antipsychotic.
Skin picking disorder might
respond to medications such as:
• selective serotonin reuptake
inhibitors (SSRIs)
• anticonvulsants such as
lamotrigine (Lamictal)
• antipsychotics such as
risperidone (Risperdal)

22. Therapies
Habit reversal training: HRT aims to help people develop skills to reduce their
harmful behaviors such as:
• Self-monitoring (awareness training)
• Identification of behavior triggers
• Modifying the environment to decrease the likelihood of picking behavior
(stimulus control)
• Identifying a substitution behavior that is incompatible with skin picking or hair
pulling (competing for response training)
Acceptance and commitment therapy: This therapy can help you learn to
accept your hair-pulling urges without acting on them.

23. Therapies
Relaxation training: This helps people learn to focus on and calm their central
nervous systems in response to stress triggers.
Family therapy: For children and adolescents, family therapy helps parents
learn to better respond to and manage symptoms.
Group therapy: Trichotillomania or excoriation can feel isolating. Groups help
people connect with others enduring a similar struggle and provide support for
one another.