HAIR TRAILING TRICHOTILLOMANIA DISEASE

People with this disorder engage in hair pulling actions when they feel tension, but instead of feeling pain, they get great pleasure from this action and then relax. (Shepherd M.C, 2021) In fact, they can not only pluck hair, but also pluck eyelashes, pubic and armpit hair. (APA)

Did you know that the definition of trichotillomania was first made in 1889 by the French dermatologist Hallepeau, not by a mental health professional, based on a child's hair pulling behavior? (Hallepeau M, 1889)

At the point of why a person behaves in such a way, if we list some factors that may be a reason for this; (Greenberg HR, 1965)

* Divorce of parents,

*Immigrating to another place,

* Changing schools,

*Physical abuse,

*We can talk about factors such as trauma, loss or perception of loss.

It will also draw your attention to the subject, while it is claimed that from an evolutionary point of view, hair pulling may be the human equivalent of self-care and grooming movements found in some animals, there are also studies showing that these behaviors are more common in animals that are in a state of tension, inhibition and arousal. (Franklin et al, 2009)

How about taking a look at a study on trichotillomania?

In a study in which 84 percent of 19 trichotillomania patients were women, demographic and phenomenological characteristics, other concomitant disorders and family history were included, it was determined that the age of onset of the disease was 15.4 years and the duration of the disease was 11 years. While it was determined that 79% of the patients engaged in hair plucking behavior, it was determined that all patients felt relief and 14% felt great pleasure during this action. The most important point that caught our eye in this study was that 2.1% of these patients were diagnosed withobsessive-compulsive disorder, 21% with dysthymia, 10.5% with generalized anxiety disorder, 5.3% with current major depressive episodes, and 15.8% with past major depressive episodes. It was also determined that 36.8% of them had personality disorders. (Vehbi Keser et al, 1999)

According to another study, the personality disorders accompanying trichotillomania were found to be histirionic, borderline and passive-aggressive personality disorders. (Swedo and Leonard, 1992)

If you encounter a complaint about trichotillomania like the following,

The 24-year-old female patient, who is single, a university student and also works as a salesperson in a furniture store, applies to a mental health specialist with the complaint of plucking her eyebrows. In line with the anamnesis taken from the client, it was learned that the behavior of playing with his eyebrows and plucking started six years ago during the study period before the university entrance exam and has continued since then. The client, who said that he received a reaction from his environment due to these behaviors, also stated that he did not have any additional discomfort. (Durmus E, 2020)

What kind of treatment would you recommend to the client based on this case?

When the literature studies are examined, it is seen that various interventions such as Cognitive Behavioral Therapy, Psychodynamic Therapy and Psychopharmacological intervention are functional. In addition, giving psychotherapy to the client and his family is the first step of the treatment plan. (Bruce et al, 2005)

However, as the most effective method in the treatment of trichotillomania, habitualreversal therapy comes to the fore. (Bloch et al, 2007) In this therapy method, there are 5 important components to be addressed: (Azrin et al, 1980)

1) Awareness Training: While the client is taught how to recognize his own behavior, he is also taught to identify behavioral stimuli within the scope of role play studies.  

2) Self-Monitoring: The client keeps a record of his/her eyebrow plucking behavior and its related components. 

3) Stimulus Control: Some techniques are shown to reduce and prevent these behaviors, such as wearing hats and gloves. 

4) Competitive response intervention: Until the impulse disappears in the client, another behavior is taught. In this intervention, the opposite movement is to create high awareness as a result of isometric stretching of the muscles involved in the movement. In addition, the behavior should provide for activities that are socially unobtrusive and qualify as normal. 

5) Stimulus-Response Intervention: When the urge to pluck the eyebrows comes, it is recommended to develop activities such as going for a walk and relaxation exercise that can replace this impulse. 

Finally, as I conclude, although there are many disorders such as trichotillomania that appear physically, but are based on psychological processes, a correct diagnosis and treatment approach is of great importance.

BIBLIOGRAPHY

Azrin, N. H, Nunn, R. G, and Frantz, S. (1980). Treatment of hairpulling (trichotillomania): a

comparative study of habit reversal and negative practice training. Journal of Behavior Therapy and

Experimental Psychiatry. 11, 13-2

American Psychiatric Association. (2013). Diagnostic and Statistical Manuel of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association.

Bruce, T. O, Barwick, L. W, and Wright, H. H. (2005). Diagnosis and management of

trichotillomania in children and adolescents. Pediatric Drugs. 7:365-376.

Bloch, M. H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R. and Nudel,

J. (2007). Systematic review: pharmacological and behavioral treatment for trichotillomania.

Biological Psychiatry. 62:839-846.

Çoban, M. C. (2021). Current Overview of Diagnosis and Treatment of Trichotillomia, Journal of Social, Humanities and Administrative Sciences, 4(12): 1193-1210.

Durmuş E, Yurumez Y. Trikotilomani (Kaş Yolma Hastalığı) ve Hipnoterapi: Olgu Sunumu. Geleneksel Ve Tamamlayıcı Anadolu Tıbbı Derg. 2020;2(2):27-30.

Franklin ME, Flessner CA, Woods DW, Keuthen NJ, PiacentiniJC, Moore P. et al. The child and adolescent trichotillomaniaimpact project descriptive psychopathology, comorbidity, functionalimpairment, and treatment utilization. J Dev Behav Pediatr2008;29(6):493-500

Greenberg HR, Sarner CA. (1965). Trichotillomania: Symptom and syndrome. Arch Gen Psychiatry, 12, 482-89.

Hallopeau M. Alopecie par grottage (trichomanie ou trichotillomani). Ann de Dermatolofie et Venerologie. 1889;10:440-41.

Swedo SE, Leonard HL. Trichotillomania: an obsessive compulsive spectrum disorder? Psychiatr Clin North Am 1992;15(4):777-90

Vehbi Keser, Raşit TUKEL, Nuray KARALI, Celal ÇALIKUŞU, Tuba ÖZPULAT Olgun. Clinical Features in Trichotillomania. . 1999; 2(1): 26-33