Trichotillomania

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Classification according to ICD-10
F63.3 Abnormal habits and
impulse control disorders
ICD-10 online (WHO version 2019)
Trichotillomania in a young woman

When Trichotillomania is a complex impulse control disorder whose augenscheinlichstes appearance is concerned is that your own hair ripped out. The term is made up of the Greek thrix = hair, tillein = pluck and mania = frenzy, madness.

history

The term was coined in 1887 by the French dermatologist François Henri Hallopeau (1842-1919), but the appearance itself was misinterpreted as a bad habit for a long time. It was not until the end of the 20th century that trichotillomania was recognized as an independent clinical picture - namely as a complex mental disorder with specific symptoms, accompanying symptoms and accompanying illnesses. Accordingly, it was included in the revised version of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) in 1987 and in ICD-10 in 1991. In the new DSM-5 , trichotillomania is classified as an obsessive-compulsive spectrum disorder.

Symptoms

The hair that is torn out is mostly hair on the head , but also, to a lesser and different extent, hair from all other body regions. This can lead to circumscribed bald spots, with new hair of different lengths still present. Around half of those affected feel compelled to maintain symmetry or remove particularly shaped hair. Following this, the hair and often the hair roots are examined carefully before they are thrown away, picked up or swallowed. The latter is known as trichophagia . Overall, almost half of those affected show oral behavior in the broader sense, so the area of ​​the mouth can be touched with the hair or this can be used as a "floss".

Pain is barely perceived when removing the hair and when it is, it is either perceived as pleasant or ignored. The pain threshold in general is not increased for those affected. The mean age of those affected at the onset of the disorder is around 13 years and thus falls during puberty , but trichotillomania can appear for the first time at any age. It has not yet been clarified whether a very early occurrence is a separate disorder or a special subgroup. Statistically speaking, boys and girls are equally affected before puberty, and later more women than men. The disorder itself can last from a few months to several years.

Affective disorders (especially depression ) and various anxiety disorders often appear as concomitant diseases . In individual studies, a good two thirds of the cases were diagnosed with the former and more than half of the cases with the latter.

Despite many similarities with symptoms of obsessive-compulsive disorder, there are important differentiators. The compulsive actions and obsessive thoughts that occur in obsessive-compulsive disorder are usually experienced as tormenting and their own thoughts do not match their own personality ( ego-dystonic ), while with trichotillomania three quarters of those affected state that they are not aware of their action. Only a third say they have an intense urge to pluck their hair. This can serve as a means to reduce an existing increased tension, but in another third it is experienced as stimulating and can serve to counteract a feeling of emptiness.

Possible causes

In the individual cases, very different triggers can lead to trichotillomania: traumatic experiences such as the death of a loved one, experiences of abuse of any kind or other serious events. In many cases, however, it is more subtle incidents in the family and social area of ​​those affected that lead to a reduced self-esteem and can trigger trichotillomania. The disorder behavior is often a reaction to aversive emotional states such as inner emptiness, fears or inner conflicts and serves to reduce tension.

Another reason given is a high susceptibility to stress and high stress exposure of those affected.

In the meantime, there are studies that also indicate a genetic predisposition.

Consequences and complications

The most visible consequence of trichotillomania is the frequent pulling, plucking and twisting of the (head) hair , which can have a disturbing effect on the environment. Another consequence is bald spots on the head (or other affected areas), which can lead to aesthetic problems, hair loss and skin problems .

Those affected often avoid situations and activities that could lead to the discovery of their illness and possible stigmatization , or the hair loss can be mistaken for an organic illness . Social isolation can result.

As a rare complication, swallowing the torn hair (trichophagia) can enable the formation of a trichobezoar (ball of hair ), which can be a rare cause of recurrent upper abdominal pain up to intestinal obstruction or intestinal perforation and is known as Rapunzel syndrome.

treatment

The effectiveness of psychotherapeutic procedures has been well documented. In particular, behavioral treatment strategies are well established in the treatment of trichotillomania. The highest effect sizes are shown by habit reversal training , which, according to a review article, leads to a demonstrable improvement in symptoms and is superior to drug treatment. Instead of the problematic behavior, alternative movements are carried out, if possible with the participation of antagonistic muscle groups (e.g. clenching a fist, clasping an object for several minutes). Another treatment technique is the " decoupling " method , in which the malfunction is first logged and then slowly replaced and unlearned. A reduction in stress levels can be achieved through the use of relaxation techniques such as autogenic training or progressive muscle relaxation .

If the quality of life is severely impaired , psychotherapeutic and medicinal measures can be combined. There is evidence of the effectiveness of glutamate modulators such as N-acetyl-cysteine , atypical neuroleptics and antidepressants .

See also

swell

  1. ↑ Giuseppe Hautmann, Jana Hercogova, Torello Lotti: Trichotillomania . In: Journal of the American Academy of Dermatology . tape 47 , no. 3 , September 2002, p. 343 , doi : 10.1067 / mjd.2002.122749 .
  2. ↑ Entrez Gene: HOXB8 homeobox B8 [Homo sapiens]. National Center for Biotechnology Information (August 12, 2006). Retrieved November 13, 2007.
  3. ↑ Hair pulling disorder gene found. BBC News (September 29, 2006). Retrieved May 1, 2007.
  4. ^ A b Jon E. Grant: Trichotillomania (hair pulling disorder) . In: Indian J Psychiatry . tape 61 , January 2019, p. 136 – S139 , doi : 10.4103 / psychiatry.IndianJPsychiatry_529_18 .
  5. ^ MH Bloch, A. Landeros-Weisenberger, P. Dombrowski, B. Kelmendi, R. Wegner, J. Nudel, C. Pittenger, JF Leckman, V. Coric: Systematic review: pharmacological and behavioral treatment for trichotillomania. In: Biological Psychiatry . Vol. 62, Vol. 8, 2007, pp. 839-846.
  6. ^ S. Moritz & M. Rufer: Movement decoupling: a self-help intervention for the treatment of trichotillomania. Journal of Behavior Therapy and Experimental Psychiatry , March 2011, Vol. 42, No. 1, pp. 74-80. doi : 10.1016 / j.jbtep.2010.07.001
  7. ↑ Steffen Moritz, University Clinic Hamburg-Eppendorf, as of January 2010.
  8. ↑ Steffi Weidt, Richard Klaghofer, Alexa Kuenburg, Annette Beatrix Bruehl, Aba Delsignore, Steffen Moritz, Michael Rufer: Internet-Based Self-Help for Trichotillomania: A Randomized Controlled Study Comparing Decoupling and Progressive Muscle Relaxation . In: Psychotherapy and Psychosomatics . tape 84 , no. 6 , p. 359-367 , doi : 10.1159 / 000431290 ( karger.com [accessed February 23, 2017]).
  9. ↑ Jon E. Grant, Brian L. Odlaug, Suck Won Kim: N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study . In: Archives of General Psychiatry . tape 66 , no. 7 , July 1, 2009, ISSN  1538-3636 , p. 756-763 , doi : 10.1001 / archgenpsychiatry.2009.60 , PMID 19581567 .
  10. ↑ Martin E Franklin, Kathryn Zagrabbe, Kristin L Benavides: Trichotillomania and its treatment: a review and recommendations . In: Expert Rev Neurother . tape 11 , no. 8 , August 2011, p. 1165–1174 , doi : 10.1586 / ern.11.93 .

literature

  • Antje Bohne: Trichotillomania , Hogrefe, Göttingen a. a. 2009, ISBN 978-3-8017-1996-8 (= progress in psychotherapy , volume 37).

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