- Last edited on March 29, 2021
Trichotillomania
Primer
Trichotillomania (hair pulling disorder), is an obsessive-compulsive spectrum disorder characterized by a long term, irresistible urge to pull out one's hair. This occurs to the degree that significant hair loss can be seen.
Epidemiology
Prevalence is 1-2% in the general population. It affects significantly more females than males. There is a high comorbidity with OCD, excoriation disorder, body dysmorphia, and tics.
DSM-5 Diagnostic Criteria
Criterion A
Criterion B
Criterion C
Criterion D
Criterion E
Criterion F
Specifiers
Specifiers
Specify if:
Severity Specifier
Specify if:
Scales
- Psychiatric Institute Trichotillomania Scale (6-item clinician rated)
- NIMH Trichotillomania Severity/Impairment Scale
Pathophysiology
Investigations
Treatment
Medications
Except for clomipramine, which has shown some proven benefit in studies, SSRIs/SNRIs are generally ineffective for trichotillomania. Alternatively, antipsychotics such as those described above, may be beneficial as primary medications. Studies have also shown promising results for N-acetylcysteine and naltrexone. The main treatment for this condition is a specific type of CBT called habit reversal training.
Psychotherapy
Habit reversal therapy (HRT) (a form of cognitive behavioural therapy) is the first-line treatment.[1] HRT's premise is that the best way to shift a habit is to diagnose and retain the old cue and reward, and to try to change only the routine itself. Thus. HRT includes cognitive restructuring, awareness training, and behavioural analysis/identification of triggers, and developing competing responses.
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Differential Diagnosis
Guidelines
Trichotillomania Guidelines
| Guideline | Location | Year | Website | |
|---|---|---|---|---|
| American Psychiatric Association (APA) | USA | 2016 | - | Link |