The exact cause of trichotillomania is unknown (idiopathic). Mutations in the SLITKR1 gene, which mediates connections between neurons, has been implicated. The imbalance between inhibitory and excitatory neurotransmitters seems to play a role as well, particularly the deficiency of serotonin. Thus, medications such as SSRIs can alleviate symptoms in these patients.
Patchy alopecia and thinning of the hair is the hallmark feature of trichotillomania. These patients may even pull at their eyebrows.
Trichotillomania is characterized by irresistible urges to pull out hair from the scalp, eyelids, eyebrows, and other areas of the body (e.g. pubic, peri-rectal). These patients usually have a strong desire to stop but are unable to do so.
The incidence of trichotillomania is highest in adolescents. However, it is important to note that patients in any age group can be affected.
Trichotillomania is considered an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders Version V. Trichotillomania also has a strong association with excoriation disorder, anxiety, and mood disorders.
Treatment of trichotillomania is primarily psychotherapy, particularly cognitive behavioral therapy with habit reversal training. Cognitive behavioral therapy (CBT) is a type of psychotherapy based on analyzing and reforming maladaptive thoughts that are contributing to emotional and behavioral distress.
Selective Serotonin Reuptake Inhibitors (SSRIs) can be used for the treatment of trichotillomania. These medications are frequently combined with cognitive behavioral therapy to achieve a greater response to therapy.
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