Trichotillomania ( TTM ), also known as hairdresser disorder , is an impulse control disorder characterized by a long-term drive that results in a person's hair pullout. It occurs at a certain level so that hair loss can be seen. Efforts to stop pulling hair usually fail. Hair removal can occur anywhere; However, the head and around the eyes are the most common. The attractive hair is such that it produces difficulties.
This disorder can occur in the family. This happens more often in those with compulsive obsessive disorders. Interesting episodes may be triggered by anxiety. People usually admit that they are pulling their hair. On examination of damaged hair can be seen. Other conditions that may arise also include dysmorphic disorders of the body, but in that condition people are removing hair to try to correct what they see as a problem in appearance.
Treatment is usually with cognitive behavioral therapy. Clomipramine drugs can also help. Trichotillomania is thought to affect one to four percent of people. Trichotillomania most often begins in childhood or adolescence. Women are more often affected than men. The name was made by FranÃÆ'§ois Henri Hallopeau in 1889, from the Greek ????/????; thrix (meaning "hair"), along with ???????; tÃÆ'llein (meaning "interesting"), and ?????; mania (meaning "madness").
Video Trichotillomania
Classification
Trichotillomania is defined as hair loss caused by induction and recurrence. These include increased tension criteria before pulling hair and satisfaction or help when pulling hair. However, some people with trichotillomania do not support the inclusion of "subsequent tension and pleasure, satisfaction, or help" as part of the criteria as many individuals with trichotillomania may not be aware that they are pulling their hair, patients who come for the diagnosis may reject the criteria for tension before pulling hair or a sense of gratification after hair is pulled.
Trichotillomania may lie in the obsessive-compulsive spectrum, also includes obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), nail biting (onychophagia) and skin picking (dermatillomania), tic disorders and eating disorders. These conditions may share clinical features, genetic contributions, and possibly treatment responses; However, the difference between trichotillomania and OCD is present in symptoms, nerve function and cognitive profile. In the sense that it is associated with an unbearable drive to perform unwanted repetitive behavior, trichotillomania is similar to some of these conditions, and the trichotillomania rate among relatives of OCD patients is higher than would be expected by chance. However, differences between the disorder and OCD have been noted, including: peak age difference at onset, comorbidity rate, gender differences, and neural dysfunction and cognitive profile. When it occurs in early childhood, it can be considered as a different clinical entity.
Because trichotillomania may be present in some age groups, it is helpful in terms of prognosis and treatment to approach three different subgroups based on age: preschoolers, adolescents, adolescents and adults.
Trichotillomania is often not a focused action, but hair pull occurs in a "trance-like" state; therefore, trichotillomania is divided into "automatic" versus "focused" hair. Children are more often in an automatic subtype, or unconscious, and may not consciously remember pulling their hair. Others may have a focus, or conscious, ritual associated with pulling hair, including looking for certain hair types to pull, pulling until hair feels "just right", or attract a response to a certain sensation. Knowledge of subtypes is helpful in determining treatment strategies.
Maps Trichotillomania
Signs and symptoms
Trichotillomania is usually limited to one or two sites, but can involve many sites. The scalp is the most common attractive site, followed by eyebrows, eyelashes, face, arms, and legs. Some of the less common areas include the pubic area, the armpit, the beard, and the chest. The classic presentation is a "Friar Tuck" form of vertex and crown alopecia. Children tend to be unattractive from areas other than the scalp.
People who suffer from trichotillomania often pull only one hair at a time and this hairy episode can last for hours at a time. Trichotillomania can enter into remission conditions such as where individuals may not experience the urge to "pull" for days, weeks, months, and even years.
Individuals with trichotillomania hair exhibits of different lengths; some damaged hair with a dull end, some new growth with a pointed tip, a few broken middle bars, or some uneven hay. Scaling of the scalp is absent, the overall hair density is normal, and the negative hair pull test (hair is not easy to pull out). Hair is often pulled out leaving an unusual shape. Individuals with trichotillomania can be a secret or embarrassing hair pulling behavior.
Additional psychological effects can be low self-esteem, often associated with being shunned by peers and afraid of socializing, because of the negative appearance and attention they may receive. Some people with trichotillomania wear hats, wigs, false eyelashes, eyebrow pencils, or their hairstyles in an attempt to avoid such attention. There seems to be a component associated with strong stress. In a low-stress environment, some show no symptoms (known as "pulls") altogether. This "exciting" is often resumed after leaving this neighborhood. Some individuals with trichotillomania may feel they are the only people with this problem because of low reporting rates.
For some people, trichotillomania is a mild problem, just frustration. But for many people, the embarrassment and embarrassment about attractive hair causes painful isolation and generates a lot of emotional distress, putting them at the risk of concurrent psychiatric disorders, such as mood disorders or anxiety. Pulling hair can cause great tension and strained relationships with family members and friends. Family members may need professional help in resolving this issue.
Other medical complications include infection, permanent hair loss, repetitive stress injury, carpal tunnel syndrome, and gastrointestinal obstruction due to trichophagia. In trichophagia, people with trichotillomania also swallow the hair they pull; in extreme cases (and rarely) this can cause hair balls (trichobezoar). Rapunzel syndrome, an extreme form of trichobezoar in which the "tail" of the hair ball extends into the intestine, can be fatal if misdiagnosed.
Environment is a big factor that affects the withdrawal of hair. Sedentary activities such as being in a relaxed environment are conducive to pulling hair. A common example of inactive activity that promotes pulling hair is to lie in bed while trying to rest or fall asleep. Extreme examples of automatic trichotillomania are found when some patients have been observed to pull their hair out while sleeping. This is called trichotillomania sleep-insulated.
Causes and pathophysiology
Anxiety, depression and obsessive-compulsive disorder are more common in people with trichotillomania. Trichotillomania has a high overlap with posttraumatic stress disorder, and some cases of trichotillomania can be triggered by stress. Another group of thoughts emphasizes attractive hair as addictive or reinforcing negatives, as it is associated with increased tension and relief afterwards. The neurocognitive model - the idea that basal ganglia play a role in habit formation and that the frontal lobes are essential to usually suppress or inhibit the habit - sees trichotillomania as a habitual disorder.
Abnormalities in the caudate nucleus are recorded in OCD, but there is no supporting evidence that this disorder can also be attributed to trichotillomania. One study showed that individuals with trichotillomania experienced a decrease in cerebral volume. These findings show some differences between OCD and trichotillomania. Lack of structural MRI studies on trichotillomania. In some MRI studies that have been done, it has been found that people with trichotillomania have more gray matter in their brains than those who do not suffer from the disorder.
It is likely that some genes give susceptibility to trichotillomania. One study identified mutations in the SLITRK1 gene, another difference identified in the serotonin 2A receptor gene, and mice with mutations in the HOXB8 gene showed abnormal behavior including hair pulling. This data is preliminary, but it can show the genetic component in trichotillomania. The more research that surrounds this relatively newly understood phenomenon, the closer the experts to determine whether or not the gene is linked.
According to Mario Capecchi, mutated microglia cells produce mice that are similar to human trichotillomania conditions. Moving the normal bone marrow to mutant mice permanently cures them of this pathology.
Diagnosis and screening
Patients may be embarrassed or actively trying to hide their symptoms. This can make the diagnosis difficult because symptoms are not always clear, or are deliberately concealed to avoid disclosure. If the patient recognizes hair pulling, diagnosis is not difficult; if the patient refuses to pull hair, the differential diagnosis must be pursued. The differential diagnosis includes evaluation for alopecia areata, iron deficiency, hypothyroidism, tinea capitis, tracheal alopecia, alopecia mucinosa, thallium poisoning, and loose anagen syndrome. In trichotillomania, a negative hair pull test.
Biopsy can be done and can help; It reveals traumatized hair follicles with perifollicular hemorrhage, fragmented hair in the dermis, empty follicles, and defective hair transplants (trichomalacia). Some catagen hair is usually seen. An alternative technique for biopsy, especially for children, is to shave part of the area involved and to observe normal hair regrowth.
Treatment
Treatment is based on a person's age. Most pre-school age children grow beyond the condition if managed conservatively. In young adults, making the diagnosis and raising awareness of the condition is an important guarantee for families and patients. Non-pharmacological interventions, including behavior modification programs, may be considered; referral to a psychologist or psychiatrist may be considered when other interventions fail. When trichotillomania begins in adulthood, it is often associated with other mental disorders, and referrals to psychologists or psychiatrists for evaluation or treatment are considered the best. Interesting hair can disappear when other conditions are treated.
Psychotherapy
Reversal training habits (HRT) have the highest success rate in treating trichotillomania. HRT has also proven to be a successful addition to treatment as a way to treat trichotillomania. With HRT, individuals are trained to learn to recognize their drive to attract and also teach them to divert this impulse. In comparison of behavior versus pharmacological therapy, cognitive behavioral therapy (including HRT) showed significant improvement over the drug alone. It also proved effective in caring for children. Biofeedback, cognitive-behavioral methods, and hypnosis can improve symptoms. Acceptance and Commitment Therapy (ACT) also shows promise in the treatment of trichotillomania. 2012 reviews found temporary evidence for "separating movement".
Medication
The United States Food and Drug Administration (FDA) has not approved any medication for trichotillomania treatment.
Drugs can be used to treat trichotillomania. Treatment with clomipramine, a tricyclic antidepressant, was demonstrated in a small double-blind study to improve symptoms, but other studies on clomipramine to treat trichotillomania have been inconsistent. Naltrexone may be a viable treatment. Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have limited utility in treating trichothillomania, and often have significant side effects. Behavioral therapy has been shown to be more effective when compared with fluoxetine or control groups. There is little research on the effectiveness of behavioral therapy along with drugs, and strong evidence from high-quality research is lacking. The treatment of acetylcysteine ​​comes from an understanding of the role of glutamate in the setting of impulse control.
Many medicines, depending on individuality, can increase hair pulling.
Device
Technology can be used to increase training of habitual reversal or behavioral therapy. Several mobile apps are available to help log behavior and focus on maintenance strategies. There is a wearable device that tracks the position of the user's hand. They generate a sound or vibration notification to notify the user of a passive hair pullout and they can document the extent of this incident over time.
Prognosis
When it occurs in early childhood (before age five), this condition is usually self-limiting and intervention is not necessary. In adults, the onset of trichotillomania may be secondary to underlying psychiatric disorders, and symptoms are generally more long-term.
Secondary infection may occur due to picking and scratching, but other complications are rare. Individuals with trichotillomania often find that support groups are helpful in life by overcoming the disorder.
Epidemiology
Although no broad population epidemiological study has been conducted in 2009, the prevalence of a lifetime trichotillomania is estimated to be between 0.6% and 4.0% of the total population. With a 1% prevalence rate, 2.5 million people in the US may have trichotillomania at some time during their lifetime.
Trichotillomania is diagnosed in all age groups; onset is more common during pre-adolescent and young adulthood, with an average age of onset between 9 and 13 years, and an important peak at 12-13. Among preschoolers, sex is equally represented; there appears to be female dominance among pre-adolescent adolescents to young adults, with between 70% and 93% of patients being female. Among adults, women usually outnumber men by 3 to 1.
"Automatic" draws occur in about three-quarters of adult patients with trichotillomania.
History
Interesting hair was first mentioned by Aristotle in the fourth century BCE, first described in modern literature in 1885, and the term trichotillomania was invented by the French dermatologist FranÃÆ'§ois Henri Hallopeau in 1889.
In 1987, trichotillomania was recognized in the Diagnostic and Statistical Manual of the American Psychiatric Association, revised third edition (DSM-III-R).
Society and culture
Support groups and internet sites can provide recommended educational materials and help people with tricks in maintaining a positive attitude and overcoming fear alone with illness.
Media
A documentary film exploring trichotillomania, Bad Hair Life , was the 2003 winner of International Health & amp; Medical Media Award for best film in psychiatry and winner of the 2004 Film Superfest Award.
Trikster is a documentary film that follows seven individuals living with trichotillomania, as they navigate the intricate emotions around the distractions, and their effects on their daily lives. The film was released digitally, on iTunes and VHX, on April 18, 2016.
Mavis Gary (Charlize Theron) in the 2011 film Young Adult suffered trichotillomania, as did Chad (Bridger Zadina) in the 2011 film Terri.
See also
- nonkrikatrik Alopecia
- Psychogenic alopecia, a form of baldness caused by excessive care in cats
- Feather-plucking
- Hurt yourself
References
External links
- Tricotilomania in Curlie (based on DMOZ)
Source of the article : Wikipedia
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