Trichotillomania Flashcards
(14 cards)
DSM -5 -obsessive-compulsive + related disorders Trich
- compulsion to pull hair
- criteria:
A) recurrent pulling out of ones hair = hair loss
B ) repeated attempts to stop
c) causes distress/ impairment - onset = beginning highschool
Trich + depression
-Keuthen et al-
- trich co-occurs with OCD + depression
- 1/3 of people with Tich experienced OCD
-1/ 2 with Trich suffer with depression
self-esteem + Trich
-Diefenbach et al-> patients with trich show low self esteem
-Mendelson et al -> self esteem sig dependent on feelings about appearance
- Diefenbach-> impact of hair loss on appearance lowers self esteem
Mediating Factors - Impaired inhibitory control
-chamberlain et al -> stop signal task
-respond to left or right arrow until stop signal appeared
- Ability to inhibit automatic arrow-tracking beh impaired in Trich
- may explain why they struggle to stop hair-pulling as its an automatic beh
conscious vs unconscious modes of hair pulling
- flessener et Al ->
- engage in both forms across dev of trich
- all trich patients pull hair automatically so could be predetermining factor/ vulnerability
Response inhibition+ self awareness
- odlaug et al-> increased cortical thickness in superior temporal gyrus= region closely linked to issues of self-awareness
- impaired response inhibition + excess cortical thickness
Habit reversal therapy
- woods -> 3 components :
1) Awareness training - detecting triggers
2) competing response training - adoption of incompatible beh (moisturiser so can’t pull hair) to teach brain to come out of compulsion
3) social support- pas comments + reminders of competing beh
Drug Treatment
- Block et al-> SSRIs are most commonly used but meta-analysis shows they are no more effective than placebo
- Tricyclics. are fairly effective
- Habit reversal is most effective
SAPAP 3 protein
- some variations in the gene are described in people with Trich
Explanatory models
- suggest hair-pulling may regulate emotional/ stressfulI states as it provides temp relief from neg emotions = reinforcement in hair pulling beh
Trigger factors
-Hair factors -> hair visual or tactile factors
- Lifestyle -> watching TV, reading , sedentary
- Emotional -> stress, irritability divorce
- Addictions -> cocaine use
clinical aspects
- leads to alopecic plaques of varying size + unusual appearance
-plaques may contain dissimilar sized hair - done with hands or instruments
-many patients report feeling guilty + shameful
Differential Diagnosis
- shouldn’t be diagnosed if its attributed to another condition
- OCD- may pull hair as part of ritual
- Body Dysmorphia -> alter appearance
-Psychotic ->pull hair in response to delusions or hallucinations
Pharmacotherapy treatment
- Anesthetics/cream to control urge scratch
