DOCSLIB.ORG

The Use of Habit Reversal to Treat Trichotillomania Following

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of Habit Reversal to Treat Trichotillomania Following The Use of Habit Reversal to Treat Trichotillomania Following the Surgical Removal of a Trichobezoar Jody Lieske, MA and Nancy Foster, PhD Munroe-Meyer Institute at the University of Nebraska Medical Center Results (continued) INTRODUCTION Procedure (continued) • Trichotillomania is rare condition that affects 1-4% of the population. In some • Self Awareness: Subject was trained to 1) look in the mirror while String and Clothing Pulling/Swallowing pretending to engage in hair/string pulling and nail biting while focusing on instances, trichophagia, or mouthing of the hair, can lead to the formation of 4 Self- how her body moved and the muscles that were used while the habit was Baseline Self-Awareness/ + trichobezoars (hairballs). Awareness/ + Competing 3.5 Competing Response + being performed; 2) identify times that she started the habit by saying “that Response + Parent/Teacher Parent/Teacher Support + Support Relaxation • Five to 18% of patients with trichotillomania also show trichophagia and was one;” and 3) record each occurrence on a 3x5 index card. 3 approximately 37.5% are at risk for forming a trichobezoar. 2.5 • Practice the Competing Response Daily: Competing responses to hair/string 2 • Trichobezoars account for 55% of all bezoars, 90% which occur in adolescent pulling and swallowing and nail biting/swallowing were generated and Per Week females. include: sitting on hands, holding a stress ball, chewing gum, and sucking 1.5 on hard candy. Frequency 1 • Behavioral interventions have been shown to be effective with treating 0.5 patients with this trichotillomania. However, additional research is needed on • The subject was encouraged to use the competing responses 1) in front of a treatments for trichotillomania when trichophagia is present. mirror for practice, 2) when she felt the urge to start her habits, 3) in 0 situations where she is likely to start her habit, and 4) for 1 minute after Session 1 Session 2 Session 3 Session 4 Session 5 • The purpose of this case study was to examine the treatment effects of habit each time she performs her habit. reversal on hair, nail, and string pulling and mouthing in a 10-year-old female who had a history of a trichobezoar. • Parental/Teacher Support: Parents and teachers were trained on how to Hair Pulling/Swallowing identify situations when the subject engaged in her habit. They were also 4 Baseline Self-Awareness/+ Self-Awareness/+ encouraged to provide support and encouragement for efforts of the subject. Competing Competing Response 3.5 Response + + Parent/Teacher • Treatment focused on behavioral interventions without the use of a Parent/Teacher Support + Relaxation Support was encouraged at the beginning/throughout treatment. Support pharmacotherapeutic intervention. 3 2.5 Frequncy PWk • Progressive Relaxation: The subject was trained to use deep breathing along Per Week with deep muscle relaxation. She was encouraged to use strategies in 2 METHOD situations where anxiety was elevated and she felt urges to engage in habits. Frequency 1.5 Subject 1 0.5 • Archival data were examined on a 10-year-old female subject who live in a 0 rural community and was treated at an outreach behavioral health clinic RESULTS Session 1 Session 2 Session 3 Session 4 Session 5 located within a primary care setting. • Data showed a decrease in the frequency of nail biting/ swallowing and hair and string pulling/swallowing. • Prior to behavioral intervention, the subject underwent surgical removal of a trichobezoar with a 3 ½ foot long tail that extended into her small intestine. DISCUSSION/LIMITATIONS Nail Biting/Swallowing • Subject identified situations that she was more likely to engage in habits and included: 1) during academic classes and 2) at night whiled attempting to fall 12 • The case study showed decrease in the frequency of targeted habits that Baseline Self-Awareness/+ Self-Awareness/+ Competing Competing asleep, an antecedent identified was any event that created anxiety, but mostly Response + Response + previously contributed to the development of a trichobezoar. Parent/Teacher Parent/Teacher when relationship problems occurred with peers. 10 Support Support + Relaxation • Given that the subject underwent a surgical procedure prior to behavior Procedure 8 treatment, the subject could have experienced adverse effects which Frequncy PWk may have contributed to behavior change. 6 • Treatment focused on four components of habit reversal procedures: 1) an Frequency Per Week • Treatment components were not implemented separately and it is increase in the subject’s self-awareness of the habit; 2) identification and 4 practice of a daily competing response; 3) use of relaxation techniques; and therefore difficult to attribute which component may be more 4) support from parents and teacher. 2 influential on treatment effects. 0 • Future research should examine children and adolescents who develop Session 1 Session 2 Session 3 Session 4 Session 5 trichophagia and are treated with or without behavioral interventions..
Load more

Recommended publications
  • A Case Report
    J Psychiatrists’ Association of Nepal Vol .4, No.1, 2015 CASE REPORT ARTICLE Childhood Trichotilomania with Atypical Treatment Response: A Case Report Das M1, Kaur A2 1. Assistant Professor, Department of Psychiatry, Government Medical College, Haldwani, Nainital (Uttarakhand) 2. Assistant Professor, Department of Community Medicine, Government Medical College, Haldwani, Nainital (Uttarakhand). E-mail *Corresponding author: [email protected] Abstract Trichotillomania once was considered as a rare disorder but now it is recognized as a psychiatric illness that is not as rare as previously thought. Standard treatment guideline of this disorder, especially for children is not available till the present date. In this report, a case of childhood trichotillomania, its various diagnostic possibilities and successful treatment with Risperidone in a child has been described. Keywords: Trichotillomania, Childhood Onset, Risperidone INTRODUCTION in infants though it is more often seen in the first French dermatologist, François Henri two decades of life, especially in female Hallopeau was the first to describe a case of self- adolescents. inflicted depilation of scalp and he coined the ICD 10 (International Classification of term Trichotillomania in 1989. This word is Diseases 10th revision) 5 has classified derived from Greek words: tricho- (hair), tillo trichotillomania in habit and impulse disorder (pull), and mania (madness). The term whereas DSM-V (Diagnostic and Statistical trichotillomania is misleading because the suffix Manual of Mental Disorders, Fifth Edition) 4 puts "mania" implies the presence of a serious it under obsessive compulsive and related psychiatric disorder. Even after 100 years of disorders. Meyer and Haag6 reported recognising the disease, etiology, natural history trichotillomania's association with stressful and treatment is not fully clear.
    [Show full text]
  • Trichotillomania: an Impulsion Beyond Hair Pulling (A Case Report)
    Iqbal MM, et al., J Clin Stud Med Case Rep 2019, 6: 70 DOI: 10.24966/CSMC-8801/100070 HSOA Journal of Clinical Studies and Medical Case Reports Case Report Trichotillomania: An Impulsion Introduction Trichotillomania evolves as an impulse control disorder in the lit- beyond Hair Pulling erature where hair puling ultimately leads to achievement of mental satisfaction and pleasure. Although rare, it has been reported in the (A Case Report) literature previously where adolescents and children between ages 9 -13 years have been frequently targeted by this psycho dermatologic morbidity [1]. Frequent misdiagnosis of trichotillomania with alope- Muhammad Mashood Iqbal*, Muhammad Ishaq Ghauri, Mohammad Shariq Mukarram, Mohammad Faisal Iftikhar and cia areata appears to be common according to studies and hence a Uzzam Ahmed Khawaja challenging task lies to clinically diagnose the former accurately [1- 3]. Trichotillomania repeatedly appears to be linked with depression, Department of Medicine, Jinnah Medical College Hospital, Karachi, Sindh, obsessive compulsive disorder, low self-esteem, poor social function- Pakistan ing and self-image [1,4]. Patients who clinically present with such psychiatric abnormalities should be evaluated for mental and behav- ioral disorders where they tend to carry out anomalous tasks in order Abstract to relieve anxiety. Introduction: Trichotillomania is a psycho dermatologic disorder Clinical interventions to precisely evaluate and further manage that has been identified as a common morbidity in children and ado- trichotillomanics require large scale studies with positive outcomes. lescents having a positive correlation with depression and Obsessive Most successful behavioral modifications and therapies such as habit Compulsive Disorder (OCD). Very few cases have been reported in reversal tend to outweigh the pharmacological approach where the the 20-30 age groups, therefore, we intend on reporting this case.
    [Show full text]
  • Trichotillomania in Childhood: Case Series and Review
    Trichotillomania in Childhood: Case Series and Review Yong-Kwang Tay, MD*; Moise L. Levy, MD‡§; and Denise W. Metry, MD‡§ ABSTRACT. Trichotillomania is a relatively common seen over a 2-year period and reviews the literature cause of childhood alopecia. We report our observations on TTM in children. of 10 children with trichotillomania seen over a 2-year period at Texas Children’s Hospital. Patient ages ranged PATIENTS AND METHODS from 9 to 14 years (mean: 11.3 years) with an equal gender This was a retrospective chart review of children diagnosed ratio. The duration of hair-pulling ranged from 1 month with TTM between April 1999 and March 2001 in the dermatology to 10 years (median: 4.6 months). The scalp alone was service at Texas Children’s Hospital. Demographic data and the affected in 8 cases, the scalp and eyelashes in 1 case, and following specifics were collected: duration of hair-pulling, site(s) the eyelashes alone in 1 case. The frontal scalp and vertex of hair loss, potential triggering factors and associated psychopa- were the most common sites affected. Associated find- thology, and treatment rendered. ings included nail-biting in 2 cases, “picking” of the skin in 1 case, and headaches in another case. Noted precipi- RESULTS tating factors in 3 patients included “stress” at home and A total of 10 children, ranging from 9 to 14 years school. Associated psychopathology included major de- old (mean: 11.3 years) with an equal gender ratio, pression in 1 case, attention-deficit/hyperactivity disor- der in 1 case, and an “anxious and nervous personality” were diagnosed with TTM over a 2-year period (Ta- in 1 case.
    [Show full text]
  • Trichotillomania: an Important Psychocutaneous Disorder
    PEDIATRIC DERMATOLOGY Series Editor: Camila K. Janniger, MD Trichotillomania: An Important Psychocutaneous Disorder Alexander M. Witkowski; Robert A. Schwartz, MD, MPH; Camila K. Janniger, MD Trichotillomania (TTM) is a type of alopecia due Epidemiology to a psychocutaneous disorder, a self-induced An exact statistical representation of the number of illness classified as an impulse control disorder individuals with TTM in the general population is but with features of both obsessive-compulsive not available.8,9 A number of these patients avoid disorder (OCD) and addictive disorders. Although visiting their physicians and going into public places most common in children, this repetitive pulling where their disorder would be revealed.9-11 In addi- out of one’s own hair can occur at any age. The tion, adults may conceal their plucking habit with target usually is hair of the scalp, eyebrows, eye- wigs, hats, and makeup. The prevalence has been lashes, and pubic area using fingers, brushes, noted to be 0.6% to 3.4% of the total population, combs, and tweezers. Therapy for TTM can with a female to male ratio of 2 to 1.12-14 The inci- be challenging. CUTISdence of TTM appears to be higher in children than Cutis. 2010;86:12-16. in adolescents and adults.15 A small percentage of patients have first-degree family members with the same disorder as well as a history of OCD, depres- richotillomania (TTM) is an unusual type sion, and alcohol and drug abuse.16-20 of alopecia classified as an impulse control T disorder but with features of both obsessive-
    [Show full text]
  • Loose Anagen Syndrome in a 2-Year-Old Female: a Case Report and Review of the Literature
    Loose Anagen Syndrome in a 2-year-old Female: A Case Report and Review of the Literature Mathew Koehler, DO,* Anne Nguyen, MS,** Navid Nami, DO*** * Dermatology Resident, 2nd year, Opti-West/College Medical Center, Long Beach, CA ** Medical Student, 4th Year, Western University of Health Sciences, College of Osteopathic Medicine, Pomona, CA *** Dermatology Residency Program Director, Opti-West/College Medical Center, Long Beach, CA Abstract Loose anagen syndrome is a rare condition of abnormal hair cornification leading to excessive and painless loss of anagen hairs from the scalp. The condition most commonly affects young females with blonde hair, but males and those with darker hair colors can be affected. Patients are known to have short, sparse hair that does not need cutting, and hairs are easily and painlessly plucked from the scalp. No known treatment exists for this rare disorder, but many patients improve with age. Case Report neck line. The patient had no notable medical Discussion We present the case of a 27-month-old female history and took no daily medicines. An older Loose anagen syndrome is an uncommon presenting to the clinic with a chief complaint brother and sister had no similar findings. She condition characterized by loosely attached hairs of diffuse hair loss for the last five months. The was growing well and meeting all developmental of the scalp leading to diffuse thinning with poor mother stated that she began finding large clumps milestones. The mother denied any major growth, thus requiring few haircuts. It was first of hair throughout the house, most notably in the traumas, psychologically stressful periods or any described in 1984 by Zaun, who called it “syndrome child’s play area.
    [Show full text]
  • Hair Pulling and Skin Picking
    Anxiety and Depression Association of America Chicago, Illinois 2014 Ruth Golomb, LCPC DISCLOSURE I am an author of two books regarding the treatment of Trichotillomania (Hair-Pulling Disorder). OBJECTIVES • Attendees will understand the etiology, prevalence and conceptualization of TTM and BFRBs • Attendees will learn about the state of the art Comprehensive Behavioral Model (ComB) for the treatment of TTM and BFRBs. • Attendees will become familiar with how to conduct treatment for these disorders. TRICHOTILLOMANIA (HAIR-PULLING DISORDER) (312.39) DSM-5 CRITERIA • Recurrent pulling of one’s own hair resulting in hair loss • Repeated attempts to decrease or stop hair pulling • Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. • Not attributable to another medical condition (e.g. a dermatological condition) or by any other disorder • Not better explained by the symptoms of another mental disorder (e.g. attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder) EXCORIATION (SKIN PICKING ) DISORDER (698.40) DSM-5 CRITERIA • Recurrent skin picking resulting in skin lesions • Repeated attempts to decrease or stop skin picking • Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning • Not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies) • Not better explained by symptoms of another mental disorder (e.g., delusions or tactile hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in BDD, stereotypies in stereotypical movement disorder, or intention to harm oneself in non-delusional self-injury.
    [Show full text]
  • A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents
    A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Xu, Liwen, Kevin X. Liu, and Maryanne M. Senna. 2017. “A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents.” Frontiers in Medicine 4 (1): 112. doi:10.3389/ fmed.2017.00112. http://dx.doi.org/10.3389/fmed.2017.00112. Published Version doi:10.3389/fmed.2017.00112 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:34375289 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA REVIEW published: 24 July 2017 doi: 10.3389/fmed.2017.00112 A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents Liwen Xu1†, Kevin X. Liu1† and Maryanne M. Senna2* 1 Harvard Medical School, Boston, MA, United States, 2 Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Common causes of alopecia in children and adolescents include alopecia areata, tinea capitis, androgenetic alopecia, traction Edited by: alopecia, trichotillomania, hair cycle disturbances, and congenital alopecia conditions.
    [Show full text]
  • A Case of Alopecia Areata Mimicking Trichotillomania 1Deepti Shukla, 2Tejas Vishwanath, 3Sandip Agrawal, 4Rachita Dhurat, 5Aseem Sharma
    IJDY A Case of Alopecia10.5005/jp-journals-10061-0008 Areata Mimicking Trichotillomania CASE REPORT A Case of Alopecia Areata Mimicking Trichotillomania 1Deepti Shukla, 2Tejas Vishwanath, 3Sandip Agrawal, 4Rachita Dhurat, 5Aseem Sharma ABSTRACT single patch of hair loss of 3 × 4 cm was present over frontal scalp at midpartition. There was no associated Alopecia areata (AA) is a common dermatological disease erythema or scaling over patch. Few broken hairs characterized by patchy areas of nonscarring alopecia. Some- times, differentiating patchy AA from trichotillomania (TTM) can were present over patch (Fig. 1). On trichoscopic exami- be difficult. We report a case of AA mimicking TTM. nation of alopecia patch done by HEINE NC1 derma- toscope, tulip hairs, miniaturized hair, and few broken Keywords: Alopecia areata, Trichotillomania, Tulip hair. hair were seen (Fig. 2). Exclamation mark hair or black How to cite this article: Shukla D, Vishwanath T, Agrawal S, Dhurat R, Sharma A. A Case of Alopecia Areata Mimicking dots were absent. Trichogram showed tulip flower- Trichotillomania. Int J Dermoscop 2017;1(1):35-37. shaped hyper pigmented distal ends of hair shaft (Fig. 3). Based on clinical and trichoscopic features, differential Source of support: Nil diagnosis were kept as TTM and AA. To make a defini- Conflict of interest: None tive diagnosis, biopsy was done from margin of alopecia patch with a 4 mm punch. The H&E section showed INTRODUCTION peribulbar lymphocytic infiltrate (Figs 4 and 5). Histo- Alopecia areata (AA) and trichotillomania (TTM) are pathological findings confirmed the diagnosis of AA. common diseases with hair loss encountered in clini- cal practice.
    [Show full text]
  • The Relationship of Psychological Trauma with Trichotillomania and Skin Picking
    Journal name: Neuropsychiatric Disease and Treatment Article Designation: Original Research Year: 2015 Volume: 11 Neuropsychiatric Disease and Treatment Dovepress Running head verso: Özten et al Running head recto: Psychological trauma with trichotillomania and skin picking open access to scientific and medical research DOI: http://dx.doi.org/10.2147/NDT.S79554 Open Access Full Text Article ORIGINAL RESEARCH The relationship of psychological trauma with trichotillomania and skin picking Eylem Özten1 Objective: Interactions between psychological, biological and environmental factors are Gökben Hızlı Sayar1 important in development of trichotillomania and skin picking. The aim of this study is to Gül Eryılmaz1 determine the relationship of traumatic life events, symptoms of post-traumatic stress disorder Gaye Kag˘an2 and dissociation in patients with diagnoses of trichotillomania and skin picking disorder. Sibel Işık3 Methods: The study included patients who was diagnosed with trichotillomania (n=23) or skin Og˘uz Karamustafalıog˘lu4 picking disorder (n=44), and healthy controls (n=37). Beck Depression Inventory, Traumatic Stress Symptoms Scale and Dissociative Experiences Scale were administered. All groups 1 Neuropsychiatry Health, Practice, checked a list of traumatic life events to determine the exposed traumatic events. and Research Center, Üsküdar University, 2Istanbul Neuropsychiatry Results: There was no statistical significance between three groups in terms of Dissociative Hospital, Üsküdar University, 3Turkish Experiences Scale
    [Show full text]
  • Trichotillomania and Trichophagia – Diagnosis, Treatment, Prevention
    Psychiatr. Pol. 2016; 50(1): 127–143 PL ISSN 0033-2674 (PRINT), ISSN 2391-5854 (ONLINE) www.psychiatriapolska.pl DOI: http://dx.doi.org/10.12740/PP/59513 Trichotillomania and trichophagia – diagnosis, treatment, prevention. The attempt to establish guidelines of treatment in Poland Marta Gawłowska-Sawosz1, Marek Wolski 2, Andrzej Kamiński 3, Piotr Albrecht4, Tomasz Wolańczyk5 1 Clinical Department of Psychiatry, Independent Public Children’s Clinical Hospital in Warsaw 2 Department of Paediatric Surgery and Urology and Paediatrics, Independent Public Children’s Clinical Hospital in Warsaw 3 Department of Paediatric Surgery and Urology, Medical University of Warsaw 4 Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw 5 Department of Child Psychiatry, Medical University of Warsaw Summary Trichotillomania is a disorder characterised by inability to control over pulling own hair from various parts of a body resulting in noticeable hair loss. Due to its long-term, progres- sive course, untreated trichotillomania can lead to disturbances in the functioning of patients and complications which are dangerous to life and health. Due to the ambiguous nature of the symptoms, they often remain unrecognised by clinicians. Most patients are afraid of revealing symptoms and reluctantly seek for professional help. In our opinion, it is necessary to increase the awareness of the disorder of physicians of different specialties to improve the detection, treatment efficacy and to prevent dangerous complications of trichotillomania. This paper summarises the current state of knowledge on the epidemiology, aetiology, clinical presentation, and treatment of trichotillomania. It is also an attempt to create guidelines in all cases of suspected trichotillomania – adapted to Polish conditions.
    [Show full text]
  • Medical Assessment of Trichophagia (Hair Ingestion)
    Suggested Recommendations Medical Assessment of Trichophagia (Hair Ingestion) A publication of the Scientific Advisory Board of The TLC Foundation for Body-Focused Repetitive Behaviors. The TLC Foundation for Body-Focused Repetitive Behaviors is a donor- supported, nonprofit organization devoted to ending the suffering caused by hair pulling disorder, skin picking disorder, and related body-focused repetitive behaviors. Our programs and services are guided by a Scientific Advisory Board of the foremost clinical and research professionals in the field. We take a com- prehensive approach to our mission: creating a community of support for affected individuals; providing referrals to treatment specialists and re- sources; training professionals to recognize and treat BFRBs; and directing research into their causes, treatment, and prevention. Authors This pamphlet is a project of The TLC Foundation for Body-Focused Repetitive Behaviors Scientific Advisory Board. Contributing Authors: Jon E. Grant, JD, MD, MPH Joseph Garner, PhD Ruth Golomb, LCPC Suzanne Mouton-Odum, PhD Carol Novak, MD Christina Pearson Jennifer Raikes The information in this booklet is not intended to provide treatment for body- focused repetitive behaviors or trichophagia. Appropriate treatment and advice should be obtained directly from a qualified and experienced doctor and/or mental health professional. TLC is a 501(c)(3) tax-exempt organization and all contributions are tax deductible. Our tax ID number is: 77-0266587. © 2017 The TLC Foundation for Body-Focused Repetitive Behaviors. All Rights Reserved. 2 Advice for Families Hair pulling (trichotillomania) is a problem which is typically described as the pulling of hair resulting in hair loss. In addition, the hair pulling is usually disruptive to some daily functioning of the individual; however, hair pulling in children can be quite different in that the child may not experience any distress about the behavior or hair loss.
    [Show full text]
  • A Psychopathological Perspective and the Psychiatric Comorbidity of Hair Pulling
    Acta Dermatovenerologica 2019;28:33-36 Acta Dermatovenerol APA Alpina, Pannonica et Adriatica doi: 10.15570/actaapa.2019.7 Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling Sarah Anwar1, Mohammad Jafferany2 ✉ Abstract Trichotillomania, or hair-pulling disorder, is classified as an obsessive-compulsive spectrum disorder and is seen predominantly in females. This is a non-systematic review article focusing on the psychopathological features of hair pulling. It is speculated that hair pulling may function to provide short-term relief from stress and other unwanted emotional states, thus serving as a method of emotion regulation. The prevalence of trichotillomania ranges from 1 to 3%. The most targeted site is the scalp, and other common areas include pubic hair and facial regions such as the eyebrows, eyelashes, and beard. Individuals suffering from this disorder tend to avoid social environments due to embarrassment regarding their appearance and fears of being judged by peers. Trichotillomania is associated with significant functional impairment and increased risks of comorbid psychiatric disorders such as other body-focused repetitive behaviors, depression, anxiety, and addictive disorders. This article reviews the epidemiology, clinical features, diagnostic criteria, and psychopathology of trichotillomania with an emphasis on psychopathology and psychi- atric comorbidity. Keywords: trichotillomania, hair pulling, psychodermatology, psychopathology Received: 7 August 2018 | Returned for modification: 16 November 2018 | Accepted: 29 October 2018 Introduction thorough clinical exam and trichoscopy are the main methods for diagnosing trichotillomania. Trichotillomania, or hair-pulling disorder, is classified as an ob- sessive-compulsive spectrum disorder. It involves repeated urges Epidemiology to remove one’s body hair, resulting in hair loss.
    [Show full text]