Trichotillomania Hair Pulling

About Trichotillomania Hair Pulling

Trichotillomania, also called hair pulling disorder, involves recurrent pulling out of hair from the scalp or body, resulting in hair loss, along with repeated attempts to stop. Pulling can occur from any body site, most often the scalp, eyebrows and eyelashes, and is often preceded by tension or an urge and followed by relief or gratification. Pulling may be focused, as a deliberate response to urges or emotions, or automatic, occurring without full awareness during sedentary activities such as reading or watching television, and many people do both. It usually begins around puberty and is classified in DSM-5 among the obsessive compulsive and related disorders, where it is grouped with skin picking as a body focused repetitive behavior. The term was coined by the French dermatologist Francois Hallopeau in 1889. Complications can include skin damage and, in people who swallow hair, a hairball in the digestive tract called a trichobezoar, which in an extended form is known as Rapunzel syndrome and may need surgical removal. Shame often leads people to hide hair loss. Habit reversal training is the best established treatment, combining awareness training, a competing response such as clenching the fists, and social support, along with stimulus control to reduce cues. Evidence for medication is limited, and options such as N acetylcysteine and clomipramine have been studied with mixed results.