Current Diagnosis & Treatment Psychiatry (9780071771948) by Ebert Michael H.; Leckman James F.; Petrakis Ismene

Author:Ebert, Michael H.; Leckman, James F.; Petrakis, Ismene
Language: eng
Format: epub
Publisher: McGraw-Hill Global Education
Published: 2019-10-15T00:00:00+00:00

C. Genetics

Family studies are suggestive of a genetic predisposition for trichotillomania but may reflect environmental learning and are inconclusive.

Clinical Findings

A. Signs & Symptoms

Patients, particularly young ones, frequently deny that they pull their hair intentionally. Others typically describe pulling their hair when alone, but they may pull it openly in front of immediate family members. These episodes tend to occur during sedentary activities such as watching television, reading, studying, lying in bed, or talking on the telephone, and they may be more frequent during periods of stress. Patients may be unaware that they are pulling their hair until they are in the middle of an episode. Some patients report being in a trancelike state when they pull their hair. These episodes may last a few minutes or a few hours. Patients may pull a few hairs or many hairs per episode. Many patients do not feel pain when the hair is pulled; some patients report that it feels good.

Patients frequently engage in oral manipulation of the hair once it is pulled including nibbling on the roots or swallowing the hair. The later behavior can lead to a rare but serious complication, a trichobezoar (hair ball) in the gastrointestinal tract. The consequences of a trichobezoar can be life threatening: obstruction, bleeding, perforation, pancreatitis, and obstructive jaundice.

Patients typically pull hair from their scalp, causing diffuse hair thinning or virtual baldness. The typical patient demonstrates patchy areas of alopecia without inflammation that spare the periphery. Many patients are adapt at hiding areas of hair loss by judicious hair styling, but may ultimately resort to hairpieces and wigs when the areas become too large or too numerous to hide. Patients may also pull hair from other parts of their body, including eyelashes, eyebrows, pubic region, or from face, trunk, extremities, or underarms.

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