"I Can't Stop Pulling My Hair!" Using Numbing Cream As an Adjunct Treatment for Trichotillomania (Practice Forum) (Case Study‪)‬

Trichotillomania (TTM) is classified as an impulse control disorder within the DSM-IV-TK (American Psychiatric Association, 2000). The main features of the disorder include recurrent hair pulling with noticeable hair loss or thinning; tension or uncomfortable feelings (for example, itch or urge) prior to pulling; and some sense of pleasure, gratification, or relief as a result of the pulling. TTM is not as rare as once thought. Lifetime prevalence rates of 0.6 percent were found for both men and women; however, subclinical symptoms of "noticeable hair loss" increase the lifetime rates to 3.4 percent for women and 1.5 percent for men (Christenson, Pyle, & Mitchell, 1991). Some researchers believe that these numbers are underestimated because of the secretive nature of the disorder (Tay, Levy, & Metry, 2004). TTM can have a significant negative impact on a person's life if left untreated. Diefenbach and colleagues (2005) found individuals with TTM report having a higher degree of distress than do individuals without hair-pulling problems, and individuals with TTM are comparable to other individuals with psychiatric disorders on reported distress levels. Consistent with this research, two studies by Wetterneck and colleagues (2006) found that TTM sufferers experience both social and economic disadvantages related to having the disorder, contributing to a higher reported distress level. Individuals with TTM demonstrate social avoidance, affecting not only their social lives, but also their academic and financial ones. Individuals with TTM report avoiding school, work, and social activities because of hair pulling. This could result in poor academic performance or retention, job loss or demotion, and social isolation and sadness. They also found that these individuals spend large amounts of time and money trying to conceal the effects of hair pulling (for example, purchasing hair extensions).