ABSTRACT
Multiple approaches to characterization of TTM have been developed, including categoric definitions and dimensional considerations. When TTM is viewed in the context of other disorders with common comorbidities and overlapping similar phenomenologies, such as OCD, body dysmorphic disorder, skin picking, TS, and olfactory reference syndrome, clinical approaches to assessment and differential diagnosis are more complex. This article presents a general overview of TTM included as a background for a heuristic clinical framework for assessing obsessive-compulsive spectrum disorders. A comprehensive behavioral model of TTM as a template is presented in the context of a broader, phenomenologic approach to assessment of several other disorders. These additional conditions were chosen on clinical grounds because they seem to share some phenomenologic characteristics with TTM. It is hoped that combining a phenomenologic approach to the differentiation of repetitive behaviors (as has been valuable in advancing the understanding of repetitive behaviors in TS and OCD), coupled with a paradigmatic comprehensive behavioral assessment and treatment model of TTM, may foster the validation of such approaches for other putative obsessive-compulsive spectrum disorders. Also, the relative intensity and frequency ascribed to the various behavioral and phenomenologic components of the conditions depicted represent clinical impressions, with varying degrees of empiric support, and require objective validation. This approach is meant to serve as a point of departure for clinical assessment of these complex, interesting, and sometimes incompletely diagnosed and inadequately treated conditions. It is hoped that empiric validation or refutation of this conceptualization will stimulate additional research and provide clinicians with a general framework for assessing patients suffering from these difficult conditions. For more information about trichotillomania, contact The Trichotillomania Learning Center (TLC), 1215 Mission Street, Santa Cruz, CA 95060 (831-457-1004; www.trich.org).
Subject(s)
Stress Disorders, Post-Traumatic/complications , Trichotillomania , Animals , Child , Cognition , Comorbidity , Disease Models, Animal , Grooming , Humans , Male , Mental Disorders/epidemiology , Models, Psychological , Prevalence , Trichotillomania/diagnosis , Trichotillomania/epidemiology , Trichotillomania/physiopathology , Trichotillomania/psychology , Trichotillomania/therapy , United States/epidemiologyABSTRACT
Patients suffering from trichotillomania are at risk for significant mood and interpersonal problems. Using a clinical sample, this study sought to clarify the nature and types of problems experienced by patients and to examine how these problems might be interrelated. The charts of 67 patients who sought treatment for trichotillomania were reviewed. The majority of patients reported problems with affect and interpersonal relationships. Public and social activities (e.g., haircuts, sexual activities) were avoided by a large number of patients. Self-esteem, shame, feelings of unattractiveness, depressed affect, and secretiveness were all interrelated, suggesting that these issues might best be conceptualized as a cluster that needs to be considered in the etiology, effects, and treatment of trichotillomania.
Subject(s)
Interpersonal Relations , Social Behavior , Trichotillomania/psychology , Adolescent , Adult , Depression/psychology , Female , Humans , Male , Middle Aged , Self Concept , ShameABSTRACT
As our knowledge of chronic hair pulling as neither rare nor benign has increased, so has the need for a comprehensive framework to guide our conceptualization of this disorder for both research and clinical work. Such a model is presented which incorporates (a) the varied antecedents that both cue the impulse to pull and facilitate pulling, (b) the wide array of behaviors involved in the actual pulling, and (c) the full range of consequences of pulling. The cyclical nature of pulling episodes is highlighted.
