From: DrN60@aol.com Date: Thu, 11 May 2000 16:33:07 EDT Subject: Web paper 3 from Sarah S kim To: pgrobste@brynmawr.edu CC: sskim@brynmawr.edu, DrN60@aol.com MIME-Version: 1.0 Professor Grobstein, i was having problems with my WWW sources. I spent quite a deal of time trying to figure it out, but I can't seem to get it to work. Sorry! Thanks Sarah S. Kim html Biology 202 2000 Third Web Report On <> Serendip Trichotillomania: an overview Sarah S. Kim For six long months my stubborn "do" Has been a major flop It parts right down the middle and Just Hangs there like a mop It fell into a pattern that Was set on New years day. And now theres nothing to be done but let it have its way As I attempt to coax my locks Into a bob that swings I'm sure I needn't mention the Frustration bad hair brings I'm trying to be patient but It's taking, on my oath A minimum of ninety days To Gain an inch of growth As hair days go, this hasn't been A banner year for mine But I expect to have it tamed By 1999 I plan to file a formal charge Down at the Hair Patrol And put my head in rehab Till my fingers learn self control by Mary Sullivan (19) The focus of this paper is to give a brief overview of the disorder Trichotillomania by outlining its symptoms, causes, and known treatments. Trichotillomania (TM) was derived from the Greek words thrix, tillein, and mania. Thrix meaning hair, tillein, to pull, and mania meaning madness. <13> (13) The fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines TM as "recurrent pulling of one's hair resulting in noticeable hair loss." <8> (8) According to the DSM-IV, individuals with TM feel an "increasing sense of tension before pulling out the hair or when attempting to resist the behavior" and feel "pleasure, gratification, or relief when pulling out the hair." a href="8"(8) In addition, in order for individuals to be diagnosed as having TM, the hair pulling can not be accounted by another mental disorder or a medical condition. Furthermore, TM individuals all must show their hair pulling to be a significant impairment in other functional areas of their lives. a href="8"(8) There has been many debates to what kind of disorder TM is. Although DSM-IV has classified TM with other impulse control disorders such as pyromania (compulsive fire setting) and kleptomania (compulsive stealing), there has been many noted similarities between trichotillomania and Obsessive Compulsive disorder. A possible theory of classifying TM is to divide the TM patients to those who resemble OCD and those who do not. a href="9"(9) TM patients with OCD, are individuals who feel anxious if they don't pull and give in to their compulsion, while TM patients who don't resemble OCD, pull hair because they feel pleasure in the act. There is no sense of pleasure for TM patients with OCD. a href="9"(9) While most of the hair pulling is usually pulled from the head by most TM individuals, hair is also pulled from the eyelashes, eyebrows, pubic areas, beard/face, mustache, arms, legs, chest, and abdomen. a href="13"(13) In addition to pulling hair, eating, observing, and twirling hair are also characteristics of TM individuals. a href="8"(8) Individuals with TM may also pull hairs from other sources other then their body, such as the hairs of dolls and pets. a href="8"(8) Hair pulling is usually done in both isolation and in front of other people depending on the individual. Other characteristics associated with TM is scratching, nail biting, gnawing, and picking of the skin. a href="8"(8) Trichotillomania often starts early in individuals around the ages of 12-14. a href="2"(2) In these early ages, TM in males is slightly more represented than females. Among the adolescents however, females are generally more represented, while in the adults, male representation is almost eliminated. a href="10"(10) So far, there has been no definite explanation for the cause of TM. One proposed theory of the etiology of TM in the female, is that hair pulling was a response from sexual frustration. a href="5"(5) Furthermore, hair pulling was used originally as an alternate for masturbation in the female. a href="5"(5) Other and more recent explanations of TM state that neurotransmitters, such as serotonin, are not working properly within the brain. Genetic arrangement, stress, psychological trauma, and the lack of negative reactions in their environment, are also suggested theories of the etiology of TM. a href="2"(2) Many individuals with TM have tried many things such as modification of diet, hypnosis, biofeedback, talk therapy, and acupuncture. a href="14"(14) However, there are only two specific methods of treatment that have been scientifically researched in being effective. These two methods of treatment are medication and behavior therapy. Their most effective medication for trichotillomania patients is medication that fall under the category of being serotonin reuptake inhibitors (SRI). Examples of SRI medication used in treating TM are Clomiparimine (anafranil), prozac (fluoxetine), zoloft (sertraline), and paxil (paroxetine). The effect of these kinds of SRI medication can be seen in through the role of the serotonin in the brain. Serotonin is a neurotransmitter that aids in transmitting the signal between the neurons. This chemical messenger flows from a nerve cell or neuron onto other neurons that act as receivers. a href="1"(1) The area they attach themselves on the receiving neuron is called a receptor site. This union of neurotransmitter and receptor site is what sets off an electrical signal. Serotonin can also be diffused or taken back to the pre-synaptic neuron through specific transport systems. a href="14"(14) Serotonin has been found to be involved in control of sleep, cognitive ability, mood, behavior, depression, and temperature regulation. a href="12"(12) Individuals with TM have been found to have low levels of serotonin. Thus to increase this level, TM patients take SRI's which work by 'plugging up' the reuptake or pre-synaptic neuron site. This 'plugging up' of the pre-synaptic site causes there to be serotonin in between the pre-synaptic and post-synaptic neuron. Some of these 'extra' serotonin will eventually be absorbed back into the post-synaptic neuron and eventually increase the overall level of serotonin in the individual. a href="14"(14) Behavior therapy is a process aimed at changing the undesirable behavior by "reinforcing acceptable behavior and suppressing (by nonreinforcement) undesirable behavior. <<"16"(16) For example, an type of behavior therapy for depression is exercising. "One of the most insidious side effects of having depression is that it encourages you to indulge in behaviors that will only make your depression worse." a href="17"(17) By exercising, this enables the individual with depression to free themselves from other counterproductive behaviors, and allows the brain to start releasing feel good hormones like endorphin that will reduce the depression. a href="17"(17) For trichotillomania, behavior therapy has proven to be successful for many patients. Habit reversal, a form of behavior therapy, was first studied by Azrin and Nun in 1973. Habit reversal aims at reversing the undesirable behavior by certain techniques such as self-awareness and competing muscle response. a href="15"(15) Self-awareness training enables the patient to be more aware of their hair-pulling behavior. Competing muscle response involves the patient being engaged in a different motoric behavior. This enables the motoric behavior to replace the undesired behavior for that short period of time. On a personal note, I found that some of the techniques of behavior therapy should be applied to every individuals lives. Whether it is visualizing a peaceful scene, taking four deep breathes, or just laughing, I believe these kinds of activities would greatly reduce many of the disorders we have today. Working hard is important, but so is your health. Be active and taking time out to really live life. This may just be the remedy for everyone. WWW Sources 1) Trichotillomania: The TM Central Home Page Gives the DSM-IV definition of TM. Also compares the similarities and differences of OCD and ICD to TM. Other information about TM is available through the home page. 2) National Mental Health Association, Gives a good overview of TM. This website is reliable and to the point. 3)B ehavior Modification Theory, A reliable article on how Behavior Modification Theory is used in treating TM 4) http://www.medscape.com/medscape/psychiatry/journal/2000/v05.n01/mh3079.penz-02.html, Clinical and Diagnostic Features, A reliable article on the clinical and diagnostic features of TM 5) Etiology, A reliable article on the etiology of TM. 6) Patient Assessment, A reliable article on the patient assessment of TM 8) Trichotillomania, The full DSM-IV description of TM. 9) Obsessive-Compulsive Spectrum Disorders: An Overview, Gives an overview of obsessive-compulsive spectrum disorders 10) Trichotillomania, A reliable source that provides some interesting facts about TM 11) Trichotillomania - a disorder of childhood, An article written by a recovered TM individual on the TM in children 12) Serotonin and Judgment, A good explanation of the role of serotonin 13) Trichotillomania Learning Center, More info on TM 14) Serotonin Basics-Part 1 , Gives a clear explanation of serotonin and SRI's 15) Is there a cure? What have people tried?, A link from a personal website. I wouldn't use this site as medical information. 16) Behavior Therapy, A clear definition of behavior therapy 17) Behavior Therapy for Depression, Different methods of behavior therapy in treating depression