Trichotillomania – Unusual Look from the Sleep Medicine Prospective

– a High School freshman.

At the recent 13th Annual National Conference on
Trichotillomania and related Body Focused Repetitive Behaviors held in Los
Angeles (there is such conference, even if you never heard of
Trichotillomania), new findings were presented about the high frequency and
significant impact of chronic hair pulling in adults. A total of 2% of the
population exhibits this condition; with the highest impact in college students
(1.5 % of male and 3.4% female students’ hair pulling habits visibly destroy
their heads). Thus, the National Institute of Health and Trichotillomania
Learning Center held a two-day conference on the plans to research the
phenomenology as well as the treatment of this affliction.

Patients often state that they experience tension prior to
hair pulling or when attempting to resist it. In contrast, pleasure,
gratification and relief in response to hair pulling are not common in every
patient. In the final analysis, hair pulling is not due to other medical disorders,
delusions or hallucinations, but reflects impairment in social functioning.

Virtually, any area of body hair might be a target for
pulling in TTM, although the scalp is the most common, 79%, followed by
eyebrows 65%, eye lashes 59%, pubic hair 43%, legs 30%, arms 17%, and 25% other
locations. In some circumstances, hair pulling affects the person’s ability to
maintain close personal relationships. This statement may be particularly true
when pulling is used to achieve anxiety reduction, but leads to an increase in
anxiety after pulling, the nature of which interferes with job duties, job
advances, and even avoidance of any type of social gathering. Academically,
many of TTM victims avoid school, although they are mostly advanced and bright
young persons. In rare instances, TTM patients became depressed and suicidal.

Whereas researchers tend to agree that TTM is common,
inflicts great damages to the person and his family, the literature regarding
the pathophysiology of this disorder is scant indeed. The general assumption is
that TTM belongs to Obsessive-Compulsive Group of disorders, for which behavior
therapy often is helpful. This is especially true when combined with
antidepressants such as clomipramine or fluoxetine (Prozac), or Opioids such as
naltexone, which also leads to significant reductions in hair pulling. New
drugs and alternative medicines are promising: N-acetyl cysteine (a dietary
supplement – amino acid and antioxidant); acamprosate (Campral – a new
anti-alcohol medication to decrease urges); baclofen (lioresal – a muscle
relaxant); isradipine (DynaCirc – a calcium channel blocker antidepressant);
ondanzetron (Zofran – a cancer anti-nauseating medication helpful to decrease
skin picking and hair pulling. As with any condition for which there are
numerous therapeutic suggestions, the final answer is yet to be heard.

Dr. Grant, a member of TLC’s Scientific Advisory Board

“We have got to come up with the answers. We have got to
come up with the treatment technologies and methodologies.”

Ref: Arline Kaplan. Trichotillomania: Great Impact, Low
Clinical Recognition.

Psychiatric Times, May
2006, p. 48-52