Trichotillomania

Of all disorders associated with impulsive actions, trichotillomania and its association with OCD has been studied particularly thoroughly. The main manifestations of trichotillomania are:

1. repeated plucking of hair;
2. the growing internal stress preceding this action;
3. pleasure or relief accompanying this action.

Most often plucked hair on the head, eyebrows, eyelashes, limbs, pubis. Some patients eat their hair (trichotilophagy). Spotted areas, devoid of hair, can become noticeable around - it forces you to wear a wig or resort to intense camouflage measures. After plucking, patients do not feel satisfaction, but rather are concerned about the appearance defect or are dissatisfied because of the inability to control their actions.

Diagnostic criteria for trichotillomania

• A. Repeated pulling of hair, leading to a noticeable loss of hair
• B. A growing sense of tension, immediately preceding the pulling of the hair or trying to resist the desire to perform this action
• C. Feeling of pleasure, satisfaction or facilitation after pulling out the hair
• D. Disorders can not be better explained by another mental disorder or general disease (eg, skin disease)
• D. The disorder causes clinically significant discomfort or disrupts the life of the patient in social, occupational or other important areas

Although hair pulling is amplified during periods of stress, it is most often observed in a situation where the patient does not take any active action, for example, watching TV, reading or going home after work. These observations suggested that trichotillomania should rather be considered a pathological habitual action than a disorder of control over impulses. The development of a "habit reversal", the method of behavioral therapy, which is most effective for trichotillomania, was first developed to combat pathological habitual actions. Some authors believe that, to trichotillomania, onychophagia and some forms of OCD, another very common condition is close - a pathological purification, manifested by the constant removal of dust, the dressing of a suit, etc.

Along with the similarity between trichotillomania and OCD, there are differences that are no less significant. Although early reports of trichotillomania have emphasized that it accompanies OCD and responds favorably to SSRIs, more recent studies have shown that trichotillomania is often found as an independent disorder, and its pharmacotherapy is often ineffective. In contrast to OCD, trichotillomania is more common in women than in men. The hypothesis that OCD and trichotillomania are associated with general pathophysiological changes in the brain was questioned after the differences between these two states were revealed using functional neuroimaging.

Although the efficacy of clomipramine in trichotillomannia has been proven by studies with double-blind control, the effectiveness of SSRIs and, most of all, fluoxetine in most controlled studies has not been confirmed. Scientists conducted an 8-week open trial of fluvoxamine (at a dose of up to 300 mg / day) in 19 patients with trichotillomania. As a result, improvement in 4 out of 5 control indices was noted with their decrease by 22-43% compared to the baseline. However, only in 4 of 19 (21%) patients the effect could be assessed by more stringent criteria as clinically significant, and by the end of the 6th month of treatment the effectiveness of the drug was lost. Even in case of a good reaction to SSRI at the beginning of treatment, spontaneous relapses are often observed with trichotillomania. More research is needed to evaluate the effectiveness of other drugs or a combination of several agents in the treatment of this complex disease.

[1], [2], [3], [4], [5]