What is trichotillomania?
Trichotillomania is a mental disorder that is classified in the DSM-IV disorders of impulse control. Who suffers from this disorder have an excessive urge to pull out his hair, both scalp hair, eyelashes and eyebrows and hair on other parts of the body. The name is derived from the Greek "trich-" (her), "till (ein)" (pull) and "mania" (madness, craziness).
By pulling out the hair bald spots, which may cause embarrassment or frustration, but further TTM sufferers lead a normal life. Some psychiatrists see trichotillomania as a form of obsessive-compulsive disorder, while others see it as a disease but as a relatively harmless form of behavior, similar to nail biting. The fact is that in any case no more personality disorders occur in TTM-patients than in others.
A phenomenon that occurs sometimes with trichotillomania is Trichophagia where the person on the hair sucks and eats them. In exceptional cases, a molded hairball can cause stomach problems.
There are several studies on the percentage of the population that suffers from trichotillomania, studies with varying results. DSM-IV believes that 1-2% of the population suffers from this condition but the DSM-IV-TR has about 0.6%. The results also depend on the interpretation of trichotillomania.
Thus, the result is 0.6% was obtained by taking into account the following criteria:
- Recurrent pulling out of one's own hair, resulting in noticeable hair loss.
- An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.
- Pleasure, gratification or relief when pulling out the hair.
- The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (eg, dermatological disease).
- The disturbance causes clinically significant distress or impairment in social, occupational, or functioning in other areas.
These are the five criteria that ascribes the DSM-IV to trichotillomania.)
If we omit one of the criteria we get very different results. Still find a lot of people underestimate trichotillomania. This is partly because they do not want to admit it, they are ashamed of the bald spots. In a study by Christenson (1995) were among the 186 patients, 172 to the female sex. In this study is 92.5% of the total group of people with trichotillomania suffers feminine. It is possible that men blame the bald spots on normal male pattern baldness or that they simply do not seek professional help.
There are many researchers who are trying to figure out the starting age for trichotillomania are starting to develop. Muller and Winkelmann 1972, Mansueto in 1990 Swedo and Leonard in 1992, Christenson in 1995 and Cohen in 1995, a few of these researchers and all have about the same result is obtained between 11 and 12 years. There is also something called "babytrichotillomanie" where children in their early years pulling hair, luckily it usually disappears by itself over time. If the compulsive hair pulling begins during the teenage years, chances are that you do not just come from.
Trichotillomania causes
One has to this day still no clear and specific cause found for trichotillomania. There are quite a few theories drawn from sources including the neurobiological perspective, the psychoanalytic perspective and causes starting from learning theory.
Neurobiological cause
Serotonin is a neurotransmitter which occurs, inter alia, in the brains. In the areas of the brains that has a major influence on the emotional and motor processes is set in a normal case serotonin. Trichotillomania, according to several sources and studies such as that of Stein in 1999 and Audenaert in 2003, caused by a deficiency of serotonin. The cause of this phenomenon itself is as unclear and unknown. There is not wanted, only the cause of serotonin in the brains, other portions of the brains are seen as possible causes.
The cortex orbitofrontalis of a man (part of the brains) stands among other skills like self-control and decision-making ability. If the operation of the cortex is disrupted orbitofrontalis, we have caused problems with self-control. In people with trichotillomania expressed this so repeatedly in undesirable behavior (hair pulling).
Psychoanalytic cause
There are two possible causes of psychoanalysis trichotillomania, and the first one is to be found in childhood. A baby needs food, attention and touches. The fulfillment of these needs the child gets a sense of safety and security. In this period will be developed, among other things, the impulse control and frustration tolerance and it is therefore important that the needs of the child to be fulfilled. If this is not the case, the basis is laid for later problems. At the age of about 2 years, the child is in the anal phase in which the will of its own attempts to penetrate. Of course there is also the will of the parents and if the child is in a dilemma, which usually leads to admit to parents. In families where anger is not tolerated the child will involve the interests of parents and so many frustrations bottled up. They are given the inability to express their anger and so they put it into obsessions and compulsions.
A second possible cause from a psychoanalytic perspective, the symbolic meaning we give to our hair. People doing research on mother-daughter relationships have seen that women with trichotillomania often suffer problems had / have with their mother. Especially in the early years of the daughter she needs food, attention and touches. Later, their ambivalent relationship, on the one hand they are dependent on each other and on the other a hostility prevails because one can never give the other what the other wants. To give an example, a mother projects her unfulfilled ambitions, such as a particular profession, her daughter. This, however, needs support and not someone they themselves should support yet. Through the support they need to receive not of her mother but rather give them getting aggressive feelings towards her. The hair can here symbolize the mother and therefore gets a lot to endure. Her hair may simply serve as a consolation for the absence of her mother.
Causes from learning theory
In learning theory suggests that one compulsive hair pulling a bad habit that is triggered by external and internal stimuli, stimuli. In 1997 Mansueta and his colleagues have studied here and the findings are extremely interesting.
- Stimuli that trigger the urge to pull out hair can be both internal and external. With internally we mean eg gray hairs that are undesirable, eyebrows must be symmetrical and so on. Here, we recognize the perfectionist character that often a person who has possession trichotillomania. External stimuli, for example, localized (car, bed) or object bound (tweezers, mirror).
- Incentives that encourage the behavior or diking: Once the basis for the so-called bad habit of pulling out hair is a matter of giving in to the desire to pull out hair or not. Factors that encourage the behavior to be tweezers and mirrors. These are examples of external factors but Mansueto also has three internal factors determined, especially the urge itself, certain attitudes that facilitate the behavior (eg, studying) and the thoughts of the person (eg, "another one and then I stop"). There are also factors that indijkend or inhibiting can work as the fear that people will see bald spots or the fear of being caught.
- Chain of behaviors: Trichotillomania is a disorder with rituals around the actual compulsive pulling of the hair itself. They have preliminary operations such as selecting a location, objects like tweezers ready. Then they go on to choose the hair that they are going to remove and caress or even just play with it. Then they pull it with a certain technique or remove it with tweezers. This last technique is used by 43% according to a study by Schlosser and colleagues in 1994. As "epilogue", the hair and the hair follicle sometimes subjected to a thorough inspection. In many cases, the hair follicle is eaten or kept as a collection and the more extreme even eat the whole hair with sometimes serious consequences!
- Consequences of pulling her hair pulling is an operation after giving a sense of fulfillment and satisfaction and even work stress reducing. So it is overall a good feeling that they get it. Therefore, the behavior will be repeated repetitive and it's hard to stop and give up those good feelings and effects. After this good feeling, however, many a sense of shame and guilt (the bald spots) and this can sometimes be a good motivation to stop the behavior.
Other possible causes
- child's illness or injury;
- death, illness or injury of a family member;
- relocation;
- alienation or separation from friends;
- going to school;
- school problems;
- menarche;
- divorce of the parents;
- short separation of parents;
- mandatory bed rest for medical reasons;
- birth of a sibling or quarrel with sibling resulting in less attention for its migratory child.
- a problem in the immune system which may result in an infection of the brain leading to the disorder.
Trichotillomania treatment
There are many treatments available which one is more effective than all the others. Medication is one of the treatments but also behavioral therapy can do wonders for people who have trichotillomania.
Medication
Clomipramine
According to science, this is the most effective medication to treat trichotillomania and also the oldest. It is a type of antidepressant that the already discussed problem with more or less serotonin dissolves.
Fluoxetine
Another word for fluoxetine prozac, and theoretically about the same effect as clomipramine. A study has shown that the effect of a placebo and fluoxetine is the same. From this we could therefore conclude that it is not an effective medication. Another study, however, showed that fluoxetine and clomipramine have the same effect. From this we can then conclude that fluoxetine would be an effective medication is like Clomipramine is one. There is so much research regarding this treatment.
Other medications
Previous 2 drugs played in the impaired functioning of serotonin, there are other medications such as stemmingsstabilatoren (eg lithium) or neuroleptic drugs that suppress certain mental functions. Another possibility are the anxiolytics, which reduce anxiety and fear ....
Behavioral
The treatment offered by behavior therapy is based on the learning theory. They see pulling out the hairs as a kind of (bad) habit.
Habit Reversal
Reversing the habit is a first treatment in which behavioral Baer in 2002, has five distinct steps. Lee Baer is a professor of psychology at Harvard Medical School and investigator of obsessive-compulsive disorder at the Massachusetts General Hospital which he has also written a book: Everything under control.
- Awareness Training (consciously let be the person habits)
- Response from teaching (a movement, response learning to unlearn old habits)
- Relaxation training (the urge to break perform habits by thinking of something else, relax)
- Contingency Management (new behavior sustain by rewarding)
- Generalization Training (self control in risky situations (eg study) and learn to deal with situations in which one can lose hair)
Other techniques
A first technique is self-monitoring, making themselves aware of the problem and write down all kinds of data such as time and location. When this is the only step in the therapy, the probability of relapse large since no techniques are taught to learn off the hair and to prevent pulling out. Another technique is aversion therapy when a person pulling out hairs. Crawford did so in 1988 an experiment with a woman who had trichotillomania. Electrodes were attached to her forearm and after half a year (7 sessions) of getting mild electric shock when they took for pulling hair preparations, she no longer felt that need. The woman was followed and has not fallen back into her old behavior. Penalties depends which together with aversion therapy and may also be effective. Then we also have confirmation that can occur as a treatment for trichotillomania. Here we are thinking of approving and confirming the good behavior through example compliments. It does so somewhat of step 4: contingency management L. Baer. The last category behavioral therapy technique we have cognitive behavioral therapy, this technique attempts patients to the interrelationships of their thoughts, feelings and actions understand.