Trichotillomania: A Constant Hair-Pulling Disorder Affecting Women - Research Paper

Introduction

Trichotillomania is a constant disorder as referred to as hair-pulling disorder which is ordinary among women. This condition involves the pulling of hair from any part of the body where the hair grows causing baldness. According to Olusoji et al. (2018), the rigorousness of the condition is determined by factors such as the part of the body that is affected and the reaction to treatment. The condition can arise with the usual being development. According to Chamberlain et al. (2007), the condition is associated with rhythmic hair pulling, high body anxiety when hair pulling is resisted and reprieve when hair is pulled from the scalp. Chamberlain et al. (2007) further stated that characteristics such as biting of the nails are widely connected with the disorder. According to Sayar and Kagan (2014), hair loss disorder has resulted in stress, anemia and carpal tunnel disorder. The rate of reporting of this condition to the specialist is minimal because of the indignity connected with trichotillomania. The affected persons tend to hide; this has resulted in a scarce understanding of the management of the condition. Nevertheless, there is a need to create wide pragmatic research since there is little information known about the disease.

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Assessment

Epidemiology

Trichotillomania was reported more than three decades ago in 1987 as an impulse control disorder. However, the name was coined between 1842 and 1919 by Francois Henri Hallopeau, who was a dermatologist. He coined the word to describe a condition that was depicted by a young male patient who had torn the hair out in tuffs. The DSM-IV TR defines the trichotillomania disorder as a recurrent action of pulling out one's hair from body parts. The action is triggered by unwavering desire caused by the urge to receive relief, gratification, and pleasure. When hair is pulled, it leads to hair loss and this creates further stress, causes shame, trauma and other psychological issues. Initially, when the disorder was first established, the treatment of the disorder was vague. However, the medical responsiveness of the condition has been increasing gradually (Stemberger et al., 2003). For the clinicians to conclude that it is trichotillomania disorder, all other mental disorders and the general medical conditions must be ruled out. According to Duke et al. (2010), the natural life occurrence of trichotillomania is 0.6 to 1.0% while the number of reported cases is about 6.5% to 16.5%. There has been a gradual increase in the incidences of trichotillomania at a prevalence rate of approximately 1%.

The gender distribution of the disorder is not consistent since various reports show different statistics. From their study, Yik and How (2016) found that the natural occurrence is high in women (3.4%) than in men (1.5%). From these statistics, females are more susceptible to the disorder than their male counterparts. However, a natural occurrence of 1:1 female to male has also been reported in a community sample. Despite different studies showing inconsistent results, most of the studies show that females affected by the disorder are more than males with a ratio of 10:1 and this leads to the conclusion that more females are susceptible to the disorder. Women have been reported to seek medical attention than men who shave the residual hair as a means to hide baldness (Ahlawat, 2017). Sayar and Kigan (2014) stated that the condition can transpire at any age. In childhood, it is connected to poor projection while in adulthood it's associated with depression.

Etiology

According to Diefenbach et al. (2009), trichotillomania develops as results of hormonal, genetic factors. Genetics plays a critical role in the development of the disorder, hence if a person portrays the behavior there is the probability that in the family lineage some people had the disorder. Besides, close relatives might portray similar symptoms. The occurrence of distinct distribution of serotonin 2A receptor genes has been reported between persons with the disorder and the subjects of comparison (Hemmings et al., 2006). Woods et al. (2006) further associated the disorder with environmental and emotional factors. Recent research work has stated that the development of this condition has been on the rise due to stress as trichotillomania causes body tension (Woods et al., 2006). People with depression can keep on pulling hair (Sayar and Kagan, 2014). It has been shown that when people confronted with severe stressful life situations or conditions, they are likely to portray trichotillomania. Also, people with impulsive disorders are more likely to have trichotillomania. Examples of such disorder include obsessive-compulsive disorder, anxiety, and depression. Age is also a factor that can lead to the development of the disorder. The age between 10 and 13 years are more susceptible to the disorder compared to other ages. Most people know to have the disease started pulling their hair between this age blanket. As people grow, the action becomes more intense and if not treated can become worse.

Symptoms of the Disorder

The signs and symptoms of trichotillomania disorder can be evident even at a young age since it can affect adolescent at an early age. Trichotillomania disorder shows a repetitive action of pulling out hair from the body parts leading to hair loss, distress, and impairment. The constant hair pulling and twisting is one of the major indicators of trichotillomania (Woods et al., 2006). Individuals suffering from the disorder pull the hair out from parts where hair grow such as eyelashes, eyebrows or scalp. However, they pull hair from various parts not one part with time. Before pulling the hair, individual portrays a persistent sense of tension and distress. However, much they try to resist the pulling they are unable and end up pulling the hair. They, therefore, possess a huge urge to pull the hair and after pulling the hair, they feel a sense of pleasure and relief and temporary stop pulling.

When the hair is pulled out, the hair loss is noticeable due to the presence of short hair, thinned and bald areas on the scalp or various body parts. According to Olusoji et al. (2018), trichotillomania is also connected to baldness, patchy hair emergence and poor self-image. Due to the presence of thin, bald or short hair, individuals start using certain hair types and rituals that favor the hair patterns left pulling the hair. The missing eyebrows and eyelashes are more evident. Other symptoms include chewing, biting or eating up the hair that has been pulled. Besides, some people start playing with the hair that they have pulled out and an even rub it across their face or lips. Other symptoms include eating the nails, chewing the lips, and picking the skin. The eating and swallowing of the pulled hair may lead to problems relating to digestion and dental. Other symptoms may include pulling hair from pets, materials, dolls, blankets, and clothes. When pulling hair from the private parts, they hide so that they are not seen by other people. However, much the individual living with the disorder try to resist and stop the pulling out behavior they fail. People scourge them and they start developing a feeling of distress. They fail to cope up well with colleagues at work and experience distress and related problems in a various social gathering. The bad image causes serious effects on the psychology of the individual. Sah et al. (2008) stated that other symptoms of trichotillomania depression and tension.

Diagnosis

The diagnosis of this disorder is not complicated especially when the patient admits they pulled hair otherwise a differential diagnosis should be considered (Woods & Houghton, 2014). The differential diagnosis can only be ignored by assessing the persons affected for the absence of any condition that imitates trichotillomania. The most common differential diagnosis includes alopecia mucosa and areata (Sayar & Kagan, 2014). Huynh et al. (2013) posited that iron deficiency and thallium poisoning are also differential diagnoses for trichotillomania. A report by Sah et al. (2008) encouraged the application of traction alopecia and hypothyroidism as differential diagnostic to trichotillomania. According to Huynh et al. (2013), medical techniques such as scalp biopsy and abdominal ultrasonography have been applied successfully to address trichotillomania. Scalp biopsy is significant in showing the stressed hair follicles, malformed hair and hair shaft in the skin (Huynh et al., 2013). Ferritin intensity and hair microscopy can be applied as a way to treat trichotillomania (Olusoji et al., 2018). Hair microscopy can be used to reveal the split hair in the dermis. The entire blood count was also reported to address trichotillomania (Sayar & Kagan, 2014). Determination of ferritin levels is carried out as a means to determine the presence of anemia (Sah et al., 2008). According to Sayar and Kagan et al. (2014), the levels of trichobezoar is determined by abdominal ultrasonography.

This criterion for diagnosis is in accordance with Diagnostic Statistical Manual 5 (DSM-5). The manual states that the person pulls hair periodically leads to loss of hair. Efforts to minimize the pulling of hair have been made. Hair loss leads to stress in many aspects of life altogether. Hair pulling is never considered as a symptom to any mental defect or medical condition.

Treatment of Disorder

There is no single universal therapy that is effective in all the cases involving the disorder, hence, there are a variety of treatment therapies used to manage the disorder.

Management

According to Chawla et al. (2013), effective control of trichotillomania is cumbersome as there is a high probability of reversion of different techniques of treatment. According to Ahlawat (2017), treatment modalities such as cognitive and behavioral therapy by applying defiant psychotic such as antidepressants have been successfully applied. Therapies such as hypnotic and psycho as well as pharmacotherapy can be utilized (Huynh et al., 2013). The application of all these aspects is influenced by factors such as the age of the affected individuals, their psychological and therapeutic condition (Ahlawat, 2017).

Cognitive-Behavioral Therapy

This is a major aspect in the treatment of trichotillomania that involves a reversal of the behavior of the individual that is affected (Sayar & Kagan, 2014). Research conducted by Ahlawat (2017) has shown that this method is effective in limiting behaviors that lead to hair loss. This method involves the affected individual in motor activities. The patient is taught an activity to implement as an alternative to pulling hair whenever the urge arises (Olusoji et al., 2018). This activity includes wearing a cap and the undeviating participation of family members of the affected individuals (Sayar & Kagan, 2014).

Pharmacotherapy

The application of medication as a way to treat the disorder is quite difficult since clinical research in this area is minimal. Research is minimal since the sizes of the samples involved in the study are small. Nevertheless, this method is key in controlling depression. The application of serotonin inhibitors such as citalopram and antipsychotics such as asenapine has been successful (Stemberger et al., 2003). Nonetheless, the application of agents such as mood stabilizers has methodological limitations and therefore it uses advisory is impeded.

Legal Aspects

Trichotillomania disorder has no critical legal issues since the uncontrollable act involves one person who inflicts pain on own self. An individual with trichotillomania disorder pulls out hair from the body part and hence does not involve other people making the legal issues less likely albeit, since the individua...