Trichotillomania

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Trichotillomania

Trichotillomania consists of repetitive, uncontrolled pulling of one's body hair. Most commonly, scalp hair, eyelashes, and eyebrows are pulled, although hair may be pulled from any location. In some cases, trichotillomania is related to an increased stress level at home or school, while for other children, it is simply a learned habit that has strengthened over time.

Treatment:  The primary treatment approach for trichotillomania is habit reversal  training combined with stress management and behavioral contracting. treatment begins with self-monitoring of hair-pulling episodes as well as the feelings that are most likely to lead to hair pulling.

Youngsters are then systematically taught a new behavior, for example, squeezing a ball or tightening their fist, that they are to do whenever they feel the urge to pull. Relaxation training and other stress management techniques are used to diminish hair-pulling urges, while reward charts help children track their progress and earn small rewards for treatment gains.  Here are a few facts:

  • 2% to 4% of the population may suffer from chronic hair pulling .... that's 8 MILLION people in the US alone!
  • The average onset of trichotillomania is 12 to 13 years old ... most are female.
  • Many different treatments are available and treatment outcome is good when appropriately accessed.
  • A sufferer sometimes experiences a sense of increasing tension before hair-pulling and can feel a sense of relief or release of tension afterward. Sometimes people even express a degree of pleasure after the hair-pulling.
  • In order of frequency, people pull hair from their scalp, eyelashes, eyebrows, pubic area, beard, mustache, arm, and legs

Trichotillomania, New Trials
A Controlled Trial of Venlafaxine
The following information was published July, 2003
in the New England Journal of Medicine, and is edited for brevity.

Beyond Panic: Medication Effects in Anxiety Disorders
A Controlled trial of Venlafaxine in Trichotillomania
by
Philip T. Ninan, M.D., Bettina Knight, B.S.N., Lori Kirk, B.S., Barbara O. Rothbaum. PhD., Jeffery Kelsey, M.D., Ph.D., and Charles B. Nemeroff, Ph.D.

Abstract: This article reports on the preliminary findings of a two-phase trial examining the efficacy of venlafaxine in trichotillomania. Phase 1 is a 12 week, open label, prospective trial of venlafaxine in trichotillomania. Venlafaxine was effective in significantly reducing the symptoms of trichotillomania; 8 of 12 patients were considered responders. The implications of the efficacy of venlafaxine in trichotillomania are discussed , including its important advantages over other available antidepressants and anxiolytic medications.

Trichotillomania is a psychiatric illness characterized by a recurrent failure to resist impulses to pull out one's hair resulting in noticeable hair loss. It affects mostly females, often at prepuberty. Trichotillomania is is prevalent in the population, about 8 million in the USA, and can cause significant distress and social impairment. It is classified as an impulse control disorder, though it is also considered an obsessive-impulsive spectrum disorder and shares components of stereotypic movement and tic disorders.

A dose of venlafaxine was tirated to a target range (150-375 mg) with efforts made to achieve 375 mg unless limited by side effects.

The average age of the participants was 38.75 years, 24-56, and the average time patients had trichotillomania was 27 years.

This preliminary study documents the beneficial effects of venlafaxine in the short-term symptomatic management of trichotillomania.

None of the patients who received a placebo responded.
The current study suggests that venlafaxine has therapeutic benefits in trichotillomania probably through powerful inhibition of both serotonin and norepinephrine uptake.

The efficacy of clomipramine and venaflaxine, and the seeming lack of benefits with flouxetine suggest that duel inhibition of the serotonin and norepinephrine reuptake are necessary for prominent treatment benefits in trichotillomania.

It is critical to examine the longer term benefits of pharmacological management of trichotillomania, Impulse control disorders, in general, and trichotillomania in particular, may be easily controlled in the short run.



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