Trichotillomania

Trichotillomania

For what seems an eternity of seconds in an eternity not quite reaching minutes, I am lost in a world of my own doing. Time stands still as I indulge in the emotion of my lips making a tactile connection with my hair. The pleasure is overwhelming. The satisfaction is over stimulating. The desire to pluck is irresistible. In complete disconnection with my awareness, suddenly I find one. This feels like a good one. I test it with my teeth. It is thick. It feels right. Caught in the vice grip of what used to be my incisors but are at this moment no more than simple, ever with me and reliable tools for self sadomasochistic desires, I gently, slowly pull and I pluck. Before long I find a worthy other, and then another, and yet another. Until, unexpectedly my eternity of disconnected awareness comes to an abrupt end. And in this rebirth of my conscious self, I am confronted with what I have been doing. I am confronted with the reality that I am a Trichotillomaniac.

The term Trichotillomania CNM) was first used in 1889 in France. It is a condition that in its early written history was mostly described in medical reports by Dermatologists. The term Trichotillomania was first used by the French Dermatologist Doctor Henri Hallopeaux, (1842-1919), to describe a hair pulling with compulsion he observed in patients he otherwise considered sane. (1) The Word Trichotillomania comes from the Greek. If you break down this term to the roots from the Greek language you have the term thrix which means hair, the

term tillein which means to pull and the term mania which means urge, desire, craving, obsession, preoccupation or compulsion. (2) Today, the term Trichotillomania (ttm) is formally defined, by the fourth edition of The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), as the "Recurrent pulling out of one's 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 (e.g., a dermatological condition). The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning." (2)

"According to the DSM-III-R, the essential feature of trichotillomania is the recurrent failure to resist impulses to pull out one's own hair. The diagnosis should not be made when hair pulling is associated with a pre-existing inflammation of the skin or is in response to a delusion or hallucination. (Table 23-5)

Table 23-5

Diagnostic Criteria for Trichotillomania

A. Recurrent failure to resist impulses to pull out one's own hair, resulting in noticeable hair loss

B. Increasing sense of tension immediately before pulling out the hair

C. Gratification or a sense of relief when pulling out the hair

D. No association with a preexisting inflammation of the skin, and not a response to a delusion or hallucination" (3)

Contrary to the time of Doctor Hallopeaux when trichotillomania was considered to be a dermatological affliction and thus was primarily treated by a dermatologist, it is now classified as an impulsive control disorder, (e.g., compulsive gambling, kleptomania or compulsive stealing and pyromania or compulsive fire setting), and is now more often than not treated by a psychiatrist. It is often associated with obsessive compulsive disorders and/or personality

disorder, borderline personality disorder and depression. Impulse disorders are characterized by the inability of the person afflicted to control or resist the impulse. The person usually feels a sense of mounting tension and states feeling a sense of relief or release of tension or a sense of gratification or pleasure immediately after.

The course of onset for this disorder is not well known. It is apparently more common in women and is thought to onset at an early age in childhood, although onsets have been known to come at any age. "One study showed that 5 of 19 children had family history of some form of alopecia"(3), (partial to complete baldness). It is believed that it is more common than research shows it to be. Pafticulally because most of the documented research involves patients that