Compulsive Hair Pulling Research Articles

Trichobezoars in children – A psychological perspective

Trichobezoars or hairballs in the gastrointestinal tract occur as a complication of trichotillomania or compulsive hair pulling, and trichophagia, or compulsive eating of hair. The DSM-5 classifies trichotillomania as an obsessive-compulsive spectrum disorder. In this case series of four children with trichobezoar, we present the varied psychopathology that led to the same and discuss the current literature on complex issues underlying trichotillomania.

Optimizing treatment of compulsive hair pulling in children and young people: A case series from a pediatric psychodermatology service.

Optimizing treatment of compulsive hair pulling in children and young people: A case series from a pediatric psychodermatology service.

Latent class analysis of emotions experienced during compulsive hair-pulling episodes

Background and objectivesReasons for compulsive hair pulling are heterogeneous and not fully understood. Given that many people who experience compulsive hair pulling do not respond to treatment, identifying subgroups can inform potential mechanisms and treatment design. MethodsWe sought to identify empirical subgroups among participants in an online treatment program for trichotillomania (N = 1728). A latent class analysis was used to identify patterns of emotions associated with compulsive hair-pulling episodes. ResultsSix classes of participants were found which reflected three predominant themes. One theme reflected expected patterns, where emotional changes were seen following pulling. Two other themes were more surprising, where one reflected high overall emotional activation that did not show consistent change in response to pulling, and another showed low emotional activation overall. These results suggest that there are multiple types of hair-pulling and a sizeable group of people may benefit from treatment adjustments. LimitationsParticipants did not receive semi-structured diagnostic assessment. A majority of participants were Caucasian, and future research would benefit from increased participant diversity. Emotions associated with compulsive hair-pulling were measured across an entire treatment program, but the relationship between specific intervention components and change in specific emotions was not systematically collected. ConclusionsWhile previous research has addressed overall phenomenology and comorbidity, the present study is the first to identify empirical subgroups of people who experience compulsive hair-pulling at the level of individual pulling episodes. Identified participant classes had distinguishing features that can aid in personalizing treatment to individual symptom presentations.

Trichotillomania with Trichophagia and Trichobezoars: A Case Report

Trichotillomania is a condition when an individual is unable to resist the urge to pull out the hair on their head or in other places. Trichophagia is the repetitive swallowing of hair most usually connected with compulsive hair pulling. Trichotillomania with trichophagia is a rare psychiatric disease. Trichobezoar, on the other hand, has been documented in several surgical studies. It is unusual to see these symptoms appear at the same time. It can affect anyone at any age, but it is more common in adolescents, with a strong female predominance. This is a case report of an unusual case in an 11-year-old girl with all three disorders occurring at the same time and presenting with intestinal obstruction. This case report aims to identify signs and symptoms of trichobezoar, mainly in adolescents, to discover similar incidents that may link to psychiatric disorders like trichotillomania and trichophagia in medical practices.

Establishing and developing a paediatric psychodermatology service and our experience of a new paediatric psychodermatology clinic during the Covid 19 pandemic.

Children and young people (CYP) with skin and hair conditions are at an increased risk of mental health problems and vice versa. Current child and adolescent mental health services are already stretched and in our experience, this unique combination of symptoms and signs requires a multi‐disciplinary approach. We report our experience of establishing a paediatric psychodermatology clinic where, at each appointment, CYP are seen by a consultant dermatologist and a clinical psychologist initially jointly and then individually to ensure all viewpoints are heard and a collaborative treatment plan can be agreed. The clinic was established one month prior to the national lockdown during the COVID‐19 pandemic and the face‐to‐face model was converted to a virtual format. CYP are now seen either face to face or virtually according to CYP/parent/carer preference and this hybrid model increases accessibility and has reduced DNA rates. Referrals were received from primary, secondary and tertiary care settings. Thirty –six new patients were seen and followed‐up over a 2 year period, age range 3–17 years old. The majority of patients presented with compulsive hair pulling (trichotillomania) and medically unexplained signs (dermatitis artefacta); other problems seen were eczema, skin picking and acne. Half of the patients required additional psychology sessions. Seventy‐six percent of patients have been discharged, almost half back to the care of their general practitioner. We use pre‐ and post‐clinic questionnaires and share these and feedback from CYP/families who have found this clinic model helpful and effective.

PS03: A case series of compulsive hair pulling (trichotillomania) in children and young people presenting at a tertiary paediatric psychodermatology clinic

PS03: A case series of compulsive hair pulling (trichotillomania) in children and young people presenting at a tertiary paediatric psychodermatology clinic

Trichoscopic Overlap of Trichotillomania Superseding Alopecia Areata: A Report of Two Cases

Trichoscopy is a non invasive tool useful for diagnosis of dermatoses on hair bearing skin. Alopecia Areata (AA) is a common non scarring alopecia with varying aetiologies including autoimmune and genetic factors. Trichotillomania (TTM) is a psychocutaneous dermatosis characterised by compulsive hair plucking leading to hair loss at accessible sites. Trichoscopy can be used for diagnosing both these dermatoses at an early stage due to presence of distinct trichoscopic signs. Authors hereby intend to report two cases presenting with a trichoscopic overlap of trichotillomania superseding alopecia areata. First case was of a 27-year-old male presented with patchy hair loss for three months over scalp. On clinical examination, the case appeared to be of AA with involvement of three well-defined patches on the scalp, though trichoscopy suggested an overlap of AA with TTM. On probing patient gave a history of stressors predominantly of unemployment due to Coronavirus Disease-2019 (COVID-19) pandemic but denied the history of compulsive hair pulling, indicating that TTM must have superseded patches AA. The second case was a 20-year-old female presenting with a single patch of hair loss over mid scalp. There was atrophy in the centre and easy pluckability at borders. Trichoscopy yet again suggested an overlap of AA with TTM. The patch of AA was persistent in the patient giving rise to depression and anxiety which had probably provoked hair plucking. TTM and AA are two distinct clinical entities but can be simultaneously present in patients. Trichoscopy can be indeed helpful for diagnosis in such cases. Treatment modalities should therefore address both these conditions in such cases for better outcomes.

From biosociality to biosolidarity: the looping effects of finding and forming social networks for body-focused repetitive behaviours

Anthropological accounts of biosociality reveal the importance of the social relations formed through shared biomedical conditions. In the context of body-focused repetitive behaviours (BFRBs), like compulsive hair pulling (trichotillomania) and skin picking (dermatillomania), biosociality moves people from isolation towards community. After diagnosis, the powerful moment of discovering ‘you are not alone’ can lead to immense personal transformations, demonstrating the ‘looping effects’ of diagnosis and biosociality. Yet, biosocial groups do not simply exist, and must first be formed and found and their sustainability requires ongoing work and care from biosocial actors themselves. Biosociality also means different things to different people, often requiring a negotiation between secrecy and disclosure. This article acknowledges the role of stigma in biosociality, differentiating between private and public biosocial experiences. It argues that through biosociality come acts of biosolidarity, where advocacy can improve the visibility and recognition of illness groups. The circular looping effects of biosociality and biosolidarity demonstrate the way that community activism and biosociality reproduce one another. Through reflections from the anthropologist, biosolidarity is considered as a methodological tool that can help scholars to navigate the boundaries between relatedness, sociality and advocacy in the field and beyond.

Development of the social concerns in individuals with body-focused repetitive behaviors (SCIB) scale

Body-focused repetitive behaviors (BFRBs) include such disorders as compulsive hair pulling, skin picking, nail biting, and cheek biting, which can lead to significant psychosocial impairment (American Psychiatric Association, 2013). As such, social concerns (i.e., concerns about how others view their behavior or affected body sites) are common in these individuals, and may significantly associate with BFRB symptomology (Snorrason et al., 2012). Currently, there are no measures to adequately assess social concerns specific to BFRBs. To this end, we developed a new self-report measure called the Social Concerns in Individuals with BFRBs (SCIB) that aimed to assess these concerns using two independent samples of individuals reporting elevated BFRB symptoms. Results showed that the overall level of social concerns reported on the SCIB significantly explained the variance in hair pulling and skin picking symptom severity even after controlling for the influence of other general social concern and emotional distress measures. Exploratory and confirmatory factor analyses provided psychometric evidence for the two-factor structure of the SCIB: (1) Concern about Physical Unattractiveness and (2) Concern about Social Disapproval, which were found to assess distinguishable aspects of BFRB-relevant social concerns. Overall, the findings suggest that the SCIB is a useful measure that can be used to evaluate social concerns in those with BFRB disorders.

Gastric Outlet Obstruction by Trichobezoar, A Case Report

A trichobezoar is a bezoar ( a mass found tapped in the gastrointestinal system) formed from the ingestion of hair. Trichobezoars are often associated with trichotillomania (compulsive hair pulling). Trichobezoars are rare, but can be fatal if undected1,2. Surgical intervention is often required. Gastric outlet obstruction (G.O.O) is one of the presenting complaints of trichobezoars in the stomach. Patients with this condition often have an underlying psychiatric illness & history may not be easily forthcoming. This condition mainly occurs in young female. We are presenting a case of gastric outlet obstruction in a young female of 25 years old. After taking history, clinical examination, necessary investigation it seemed to be a case of trichobezoar. Laparatomy done under general anaesthesia, then opened the stomach and found it was a case of trichobezoar.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 85-87

“Pulling hair out of the head” - the importance of traumatic family events in the development and maintenance of trichotillomania symptoms - case report

Abstract Introduction: Trichotillomania is a mental disorder characterized by a repetitive and compulsive hair pulling, classified in ICD-10 to a group of habit and impulse disorders, and in the DSM-5 to the group of obsessive-compulsive disorders. Aim: The aim of the study is to present on the basis of case study:1). the importance of traumatic family experiences in releasing as well as maintaining the symptoms of Trichotillomania, 2). comprehensive medical care, the application of which has resulted in a beneficial therapeutic effect. Results: In the described case of 16-year-old patient, Trichotillomania was triggered by traumatic events related to lack of support and family stabilization resulting from parental disputes and grandfather’s death, when she was 11 years old. The subsequent years of her life, in spite of the divorce of her parents and their separate residence, abounded in periods of turbulent quarrels between the parents in which she was involved. Each time this type of incident was associated with the recurrence of behavior associated with Trichotil-lomania, the course of which was more severe with the occurrence of self-harm and suicidal thoughts. Conclusions: 1. In the described case, traumatic events and pathological relations of the immediate family members were not only thetriggering factor, but also maintaining the Trichotillomania symptoms. 2. In accordance with the guidelines of Trichotillomania Learning Center-Scientific Advisory Board (2008), the use of a comprehensive treatment including both the patient - individual psycho-therapy (especially cognitive-behavioral therapy) and pharmacotherapy, as well as her family (family psychotherapy, family mediation, workshops for parents), brought about positive therapeutic effects.

Trichobezoar due to psychiatric co-morbidity: A rare case report

Trichobezoar (hair ball) is characterized by the accumulation of hair in the gastrointestinal tract. It is formed by trichophagia (ingestion of hair) and often associated with trichotillomania (compulsive hair pulling) and other psychiatric disorder or neurological problems. We report a case of 19-year-old female who had a trichobezoar. Trichotillomania and depression are the common psychiatric disorders associated with trichobezoar, hence it should be always looked for and treated along with its surgical management. The patient underwent laparotomy during which a large trichobezoar was removed. This case report highlights the importance of psychiatric and comprehensive approaches.

EPA-0270 – Trichotillomania and other co-morbdity in intellectually disabled children. two case studies

Trichotillomania is a psychiatric disorder characterized by an urge to pull out hair from the scalp or other parts of the body (Impulse Control Disorder) relatively uncommon in children. The following two clinical vignette highlight varying presentation of trichotillomania in children from two differing age groups (>6 yrs and <12 yrs) To showcase 2 cases of trichotillomania with differing co-morbidities. ICD 10 (WHO) was the primary diagnostic tool used here. MGH Hair Pulling Scale was used for rating the severity of Trichotillomania. As both patients had suspected mental sub normality, WISC was used for IQ assessment. Case 1: Trichotillomania with OCD and ?Secondary depression with MR 14 year old female, presented with compulsive eyebrow pulling for 1 year. For last 6 months showing OCD and depressive symptoms. She scored 32 on YBOCS with main obsession – excessive concerns with germs and main compulsions - excessive or ritualized hygiene. On MGH hair Pulling scale she scored 21. Her IQ score was 65, suggesting Mild Intellectual Disability. Case 2: Trichotillomania with Pica and MR 5 year old female, presented with compulsive hair pulling and ingesting it (Trichophagia) for 18 months. Also eating non edible things like soil and paper (Pica). No major physical illness found. On MGH Hair Pulling Scale, she scored 17. X-ray of GIT showed no Trichobezoar (hair ball). Her IQ was 60, (Mild Intellectual Disability). The study illustrates how trichotillomania can be a part of a more complex psychiatric presentation with co-morbidities

Age at Onset in Trichotillomania

Trichotillomania (TTM), or compulsive hair pulling, is a common psychiatric disorder characterized by psychosocial impairment and reduced quality of life. The aim of this retrospective study was to characterize the impact of age at TTM onset on clinical variables and neuropsychological function using a variety of clinical and neurocognitive measures. The study sample included 98 adult treatment-seeking individuals with a DSM-IV diagnosis of TTM. Correlates were explored by grouping participants into childhood-onset (onset at ≤ 11 years old, n = 42) or later-onset (≥ 12 years old, n = 56) TTM and via linear regression. All subjects underwent a semistructured clinical interview with a psychiatrist and completed a variety of paper-pencil tests regarding TTM severity and quality of life. A subset (n = 44) of subjects underwent neurocognitive testing assessing motor inhibition and set-shifting compared to a sample (n = 27) of age- and gender-matched healthy controls. Data were collected from September 2006 through July 2011. Postpubertal age at onset was significantly associated with greater TTM symptom severity. Clinically, the later-onset group pulled their hair for a significantly greater amount of time daily (P = .008), had higher clinician-rated TTM severity on the Clinical Global Impressions-Severity of Illness scale (P = .042), and had higher patient-rated severity on the Massachusetts General Hospital Hairpulling Scale (P = .022) compared to healthy controls. On the neurocognitive tasks, later-onset TTM was characterized by stop-signal impairments (P = .020) and relatively spared set-shifting, consistent with previous studies in the literature. In contrast, the childhood-onset manifestation was associated with set-shifting deficits in stages of the task completed and total errors adjusted (both P < .001) but relatively spared stop-signal performance compared to healthy controls. Results indicate that childhood-onset of TTM is common, as confirmed by the fact that 42.9% of our sample met childhood-onset criteria, and may differ neurobiologically from the prototypical later-onset form. Future neurobiological and treatment studies should measure age at onset and explore further these putative differences.Trial Registration ClinicalTrials.gov identifiers: NCT00354770 and NCT00775229.

Pediatric Trichotillomania: Clinical Presentation, Treatment, and Implications for Nursing Professionals

Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace.

A Bone to Pick with Compulsive Behavior

Mice with mutations in the Hoxb8 gene exhibit compulsive grooming behavior. Chen et al. (2010) now report that this behavior stems from Hoxb8 deficiency in microglia, a type of immune cell in the brain derived from bone marrow. These findings provide intriguing connections between immune dysfunction and neuropsychiatric disorders.

Beneficial Effects of the Antiglutamatergic Agent Riluzole in a Patient Diagnosed With Trichotillomania

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: Trichotillomania is an impulse control disorder characterized by compulsive hairpulling. While the incidence of hairpulling is quite high in some populations, full criteria for trichotillomania are met by less than 1% of the population.1-3 Severe cases can lead to bald patches and marked social disability.

Escitalopram treatment of trichotillomania.

With the understanding that serotonergic drugs might curb compulsive hair pulling, we conducted a preliminary investigation examining the effectiveness of escitalopram, a potent and selective serotonin uptake inhibitor, in the treatment of trichotillomania. Twenty women meeting the Diagnostic and Statistical Manual-IV-Text revision criteria for trichotillomania participated in a 12-week open-label trial of treatment with escitalopram 10-30 mg/day. Response was prospectively defined as meeting the following criteria: (i) clinician version of clinical global impressions-improvement scale score of 1 or 2 (very much improved or much improved), and (ii) > or =50% reduction from baseline in the National Institute of Mental Health trichotillomania severity scale total score. Sixteen individuals, who had at least one postbaseline assessment, were included in the intention-to-treat analysis. Eight individuals (50%) were judged to be responders. Trichotillomania severity scale mean (SE) total score decreased significantly over time in the intention-to-treat analysis [15.4 (0.9)-9.4 (1.4); F=7.3; P<0.0001] and for completers [15.8 (1.0)-7.5 (1.2); F=10.1; P<0.0001]. Side effects were mild. Escitalopram treatment for 12 weeks led to significant improvement of trichotillomania in some patients in this small open-label trial.

A neuropsychological comparison of obsessive–compulsive disorder and trichotillomania

Background: Obsessive–compulsive disorder (OCD) and trichotillomania (compulsive hair-pulling) share overlapping co-morbidity, familial transmission, and phenomenology. However, the extent to which these disorders share a common cognitive phenotype has yet to be elucidated using patients without confounding co-morbidities. Aim: To compare neurocognitive functioning in co-morbidity-free patients with OCD and trichotillomania, focusing on domains of learning and memory, executive function, affective processing, reflection-impulsivity and decision-making. Method: Twenty patients with OCD, 20 patients with trichotillomania, and 20 matched controls undertook neuropsychological assessment after meeting stringent inclusion criteria. Results: Groups were matched for age, education, verbal IQ, and gender. The OCD and trichotillomania groups were impaired on spatial working memory. Only OCD patients showed additional impairments on executive planning and visual pattern recognition memory, and missed more responses to sad target words than other groups on an affective go/no-go task. Furthermore, OCD patients failed to modulate their behaviour between conditions on the reflection-impulsivity test, suggestive of cognitive inflexibility. Both clinical groups showed intact decision-making and probabilistic reversal learning. Conclusions: OCD and trichotillomania shared overlapping spatial working memory problems, but neuropsychological dysfunction in OCD spanned additional domains that were intact in trichotillomania. Findings are discussed in relation to likely fronto-striatal neural substrates and future research directions.

Strategy implementation in obsessive-compulsive disorder and trichotillomania.

The use of strategies to aid performance when undertaking neuropsychological tasks is dependent on intact fronto-striatal circuitry, and growing evidence suggests impaired spontaneous use of strategies in patients with obsessive-compulsive disorder (OCD). However, studies to date have not examined the effects of strategy training on task performance in OCD or in trichotillomania (compulsive hair-pulling, a condition that has been argued to share overlap with OCD in terms of phenomenology and co-morbidity). The ability to generate novel visuospatial sequences using a computer interface was examined before and after undertaking optimal strategy training in 20 OCD patients, 17 trichotillomania patients, and 20 controls (matched for age, education, and IQ). OCD patients failed to improve ability to generate novel sequences above baseline despite successfully completing strategy training to the same extent as other groups. In contrast, performance of trichotillomania patients improved significantly after training to the same extent as controls. Groups did not differ on memory span, trial-by-trial action monitoring, or ability to generate novel visuospatial sequences prior to strategy training. Strategy implementation deficits, suggestive of cognitive inflexibility and fronto-striatal dysfunction, appear integral to the neurocognitive profile of OCD but not trichotillomania. Future research should investigate cognitive flexibility in obsessive-compulsive spectrum disorders using a variety of paradigms, and clarify the contribution of specific neural structures and transmitter systems to deficits reported.