Impulse Control Disorders Trichotillomania

The prominent feature of these disorders is the repeatedly inability to stop behaving impulsively, or to resist the desire for short term satisfaction from behaviors and actions that result in great long term loss or harm.

Like other psychological disorders there is an inability to retain or to gain control in various situations. The absence of control is viewed by the treating physician as a component of the overall disorder, but not as the disorder, itself, since for a specific diagnosis, other symptoms must be observed and evaluated.

There is some form of pleasure or tension relief from the behavior, even when the behavior is disfiguring or painful. There is tension before the act of compulsion and there is either pleasure or relief afterward.

Trichotillomania involves the above issues and is manifested by pulling the hair out of the head or from other parts of the body. In a severe case, there is significant hair loss, disfigurement and difficulty in dealing with life situations because of the disfigurement. Hair loss from other diseases or conditions is not considered in these cases.

It is estimated that 4 percent of people incur this disorder who are primarily women. The cause of which is not clear. In many cases, a dermatologist will be consulted and a biopsy done to rule out other causes, such as infection, before a psychological issue as the cause is discussed.

The symptoms manifest in constant behavior of pulling the hair until it breaks off or comes out at the root. There will be either patches of missing hair or diffuse sections of broken or missing hair. In the case of eating the hair, bowel obstructions can result. There is denial of the behavior, but there are senses of increasing tension and then relief, then gratification or satisfaction as part of the process. In some cases, hair pulling can accompany other self injuring behaviors.

In children who start hair pulling before age six, the typical resolution is for the problem to go away. The earlier that the problem is detected, the better the chances of successfully treating the problem. In older children, the problem might be more difficult to resolve, or may require professional help in order to treat the problem.

While there is no agreement on use of drug therapy to treat trichotillomania, some seritonin reuptake inhibitors and naltrexone have been prescribed. Behavioral therapy with emphasis on reversing habitual behavior may be effective.