Trichotillomania (TTM) is a complex, secretive condition of distressed hair pulling (O'Sullivan et al., 2000). There are limited data on the phenomenology of this disorder, but it appears to share many features with the other OCD spectrum disorders (Swedo and Leonard, 1992). TTM is characterized by the recurrent pulling out of one's hair resulting in noticeable hair loss. There is increased tension immediately before pulling or when attempting to resist the urge to pull and a sense of gratification or relief after the "right" hair has been plucked. This cycle must cause significant distress or impairment in order for the diagnosis of TTM to be made (American Psychiatric Association, 2000). Many people who suffer from problematic hair pulling do not meet the strict DSM-IV criteria, as they may not experience anxiety preceding the hair pulling and/or conscious relief after completing the behavior. The prevalence rate for TTM based on DSM-IIIR criteria in college students was found to be 0.6 percent, but when subthreshold hair pulling was included, this rose to 1.5 percent for males and 3.4
percent for females (Christenson et al., 1991a). Hair pulling is often comorbid with other psychiatric conditions, most commonly mood and anxiety disorders (Christenson et al., 1991b). Effective treatment of TTM involves a combination of behavioral psychotherapy, psychoeducation, peer support, and/or pharmacotherapy (Keuthen et al., 1998; Minichiello et al., 1994). Although the Food and Drug Administration (FDA) has not currently approved any medications for the treatment of TTM, several classes of medications, including the SRIs, have been reported to be of benefit (O'Sullivan et al., 1999).
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