April 15, 2022 • 19 mins
If you have a constant urge to yank out the hair on your head, eyelashes or other parts of your body, you may have a disorder known as trichotillomania. It’s surprisingly common, but most people who have it don’t seek treatment. Dr. Saltz reveals the steps to take to resolve the problem.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. The topic of tricotillomania
has been on the minds of many ever since comedian
Amy Schumer revealed she has continued to struggle with it.
So today I am answering a listener's question about her
struggle with hair pulling. Trick tilla mania is a chronic,
(00:50):
repetitive hair pulling disorder, which is an often debilitating psychiatric
condition that's characterized by recurrent pulling out of one's own hair,
leading to hair loss and, as a result, difficulty in
social functioning. Although discussed in the medical literature for over
(01:10):
a century, trick it till a Mania was not officially
included as a mental health disorder in the American Psychiatrics
Association's Diagnostic and Statistical Manual until nine, when it was
classified as an impulse control disorder, but in the most
current edition, trick till a Mania is included in the
(01:31):
chapter on obsessive, compulsive and related disorders with O C
D excoriation disorder, body dysmorphic disorder, and hoarding disorders. The
current criteria for diagnosing trick tolumnia are first are recurrent
pulling out of one's hair resulting in hair loss, also
(01:53):
repeated attempts to decrease or stop hair pulling. The hair
pulling causes lynnely significant distress or impairment in social or
work or other important areas of functioning that the hair
pulling or hair loss is not attributable to another medical
(02:13):
condition like some sort of dermatologic problem, and the hair
pulling is not better explained by the symptoms of another
mental disorder. For example, if you see it's a result
of the person believing that they have a defect or
flaw in their appearance and they need to do this
because that would qualify as body dysmorphic disorder. Nationwide studies
(02:38):
of trichotillomania are actually kind of lacking, but small studies
that examine how common it is among college students, for example,
and another one in terms of adolescence in Israel and
older adults within the community have found that the rates
range from a half a percent to two percent of
the entire population, which actually a fair number of people
(03:03):
in adults. Trick It tell a mania appears to have
a large female preponderance. In fact, it's for women for
everyone man. In childhood, interestingly, it's about equal, but as
you grow up more women suffer than men. And the
behavior hair pulling appears to be quite common and often
(03:27):
presents along a continuum, So from mild to severe. You
may have mild trick it till a mania, but you
could have very severe as well, and when you have
this diagnosis one should really consider treatment. Typically, this disorder
starts at the young age of ten to thirteen, and
(03:50):
this is true no matter which culture or which place
you're located. Pulling the hair can be undertaken at any
botty lee region that has hair. The scalp is the
most common at, but followed by eyebrows at and actually
even pubic hair as common as fifty of people who
(04:13):
struggle with trick A tillomania. Triggers to pull can be sensory,
so in other words, the hair's thickness or length, or
location or physical sensations you have on the scalp might
be a trigger. They could be emotional, so some people
pull because they feel anxious or bored, or tense or angry,
(04:35):
or they could be cognitive, in other words, based on
thoughts about your hair or your parents, or some sort
of misinterpretation of your environment. Many patients report not being
fully aware of their pulling behaviors at least some of
the time. This is known as automatic pulling, as opposed
(04:57):
to focus pulling, would in contrast, occurs when the patient
sees or feels a hair that is just in their
mind not right, or that the hair fills course or
irregular or somehow out of place. People with tricker till
a mania can experience low self esteem and social anxiety
(05:20):
due to their inability to stop pulling and due to
the resulting what's called alopecia or patches of no hair.
People frequently report failure to pursue job advancement or avoiding
of a job interview even because of the pulling. Nearly
a third of adults with trickle till a mania report
(05:41):
a low or very low quality of life, so this
is a disorder that has significant impact, it can result
in unwanted medical consequences. For example, pulling of hair can
lead to skin damage if sharp instruments are used, which
sometimes they are like twee users or scissors. Over of
(06:04):
patients eat the hair after pulling it out, which is
called tricophagia, which can result in gastro intestinal obstruction and
the formation of intestinal hair balls called trichobees ors, requiring
surgical intervention in extreme cases. Although the course of the
illness can vary when untreated, trick at alumnia is commonly
(06:28):
a chronic disorder with fluctuations in intensity over time, but
for the most part, studies have found that the mean
duration of the illness is close to twenty two years.
Individuals report that the symptoms of their pulling, although they
wax and wane in intensity, they do usually persist without treatment.
(06:52):
Now interestingly, most people don't seek treatment. In fact, one
study of a thousand forty eight individuals found that only
thirty nine point five percent had sought treatment from a
therapist and only twenty seven point three sought treatment from
a psychiatrist. One reason for this low rate of treatment
(07:13):
seems to be that the vast majority of individuals with tricotelomania,
as many as eight seven feel that providers don't know
enough about the disorder, which really is not correct. Other
reasons for non treatment can include feelings of shame and embarrassment,
lack of awareness that hair pulling constitutes a recognized medical condition,
(07:37):
and fear of the professional's reaction. Trick Tellomania often occurs
with a variety of other disorders, so major depression, anxiety disorders,
substance use disorders can often occur together with trick Tello mania.
Usually the other disorders started first. Also, many people with
(08:02):
trick till A mania report anxiety and depression due to
the pulling, so that may occur afterwards, so therapists when
they see a patient really need to screen or both
trick atilla mania as well as the secondary manifestation of
the behavior if treatment is going to be successful. Interestingly,
(08:22):
trick tilla mania is often misdiagnosed as obsessive compulsive disorder.
This may partially be because rates of co occurring o
c D are significantly higher in people with trick till
A mania, as high as than those found in the
general community. The repetitive motor symptom of hair pulling share
(08:45):
some similarities with the repetitive compulsive rituals in O c D,
so this raises the possibility of an underlying common neurobiological
pathway for the two disorders. But seven lines of evidence
suggests that trick to le mania is distinct from O
c D. People with trick Telemannia are more likely to
(09:05):
be female, who also report higher rates of repetitive behavior
disorders like skin picking or compulsive neo biding, and are
more likely to have a first degree relative who has
skin picking or neo biding. Compulsions in O c D
are often driven by intrusive thoughts, but by contrast, hair
(09:29):
pulling is rarely driven by those kinds of intrusive thoughts
and it's not part of the diagnostic criteria. Also, while
trick its Lumania symptoms typically start in early adolescence, o
c D usually starts in late adolescence. And in addition,
proof that these disorders are different, treatment approaches should differ.
(09:54):
For example, the exposure and response prevention used for O
c D and how reversal used for trick it tolemania
with ss R eyes saratonin reuptake inhibitor medication showing efficacy
and treating O c D, but not for tricking tilemania.
Trickertlemania does run in families, so sometimes one person in
(10:17):
the family will realize that's what the other person is doing.
And many patients describe feelings of relief in response to
pulling hair, and so it turns out it can be
a way of dealing with negative emotions. So with that,
right after the break, we'll get to my listeners question.
(10:51):
Welcome back. Let's get to my listeners question and see
how can I help Dear Dr Saltz. When where I
wear mascara, I find myself scraping it off over the
course of the day and at the same time pulling
out some eyelashes. I find it hard to resist doing this,
(11:12):
and because I've pulled out some eyelashes, I feel like
I need the mascara even more to fill in more
thin or bare areas around my eyes. But then I'm
caught in this vicious loop of pulling on the mascara
lashes and losing more and more lashes. This has been
a problem off and on since I'm a teenager, but
(11:32):
it's really bothering me. What can I do to stop
pulling out eyelashes is actually a symptom of trigotillomania. That
you have recurrently had this problem since your teens and
can't really stop heightens the concern that this is indeed trigotillomania.
(11:53):
Trigotillomania is not only pulling out hair on the head.
It can be any hair anywhere, and eyebrows, eyelashes, and
even pubic hair are not uncommon. Even if any one
of these areas is the only place that you pull,
that you tend to pull mostly when there is mascara
on your lashes may simply mean that mascara, which has
(12:16):
a rough and thick feeling to it to the touch
on your lashes, is serving as a trigger to make
you want to pull more. Like other picking disorders, there
is often a component of feeling a need to make
things smooth or unblemished in some way, and trying to
pull off the mascara and subsequently the lash may have
(12:38):
to do with the feeling that you need to remove
any roughness and get the hair just right, so to speak.
Given that this has been with you a long time,
it may be that you cannot stop this on your own,
but you can first try I would suggest you need
to stop wearing mascara if it's a clear trigger, which
(13:01):
it sounds like it is. Avoiding the trigger will allow
you to decrease and possibly stop the behavior. Try using
an eye pencil to draw a line to fill in
around your eyes. Maybe not quite as good, but some
method of accomplishing what you want while still not using mascara.
(13:23):
Do not have anything coding your remaining lashes. If you
are able to not touch your eyes with no masscara,
then you may be able to allow your lashes to
grow in and not be a messk era user going forward,
because it will probably always be a trigger. Remembering trigger
(13:44):
to la mania is a chronic disorder, but in this instance,
be on the lookout for pulling hair in another location
because sometimes it can move areas. If this doesn't work, though,
you should see a professional who eats this disorder. Most typically,
you will start with what is called habit reversal training.
(14:07):
This helps you to queue into what triggers you to
start pulling, what feeling happens just before you do pull,
and then in recognizing it, you want to develop what's
called a competing behavior, which is another behavior that in
some ways is like the opposite of the pulling, so,
(14:27):
for example, clenching your fists in your lap so you
essentially can't pull. You practice doing this actively for thirty
minutes to an hour per day under the guidance of
the professional. Over time, the pulling diminishes. Some people do
need medication if the severity is such that habit reversal
(14:50):
alone doesn't work, I would advise you to get treatment soon,
because the longer this goes on, the harder it is
to stop, and the more effect it has on your life.
Treatment is time limited and often quite effective. I hope
that was helpful. As I mentioned earlier, individuals with trichotillomania
(15:15):
rarely seek psychological or psychiatric treatment for their condition. Patients
avoid seeking treatment due to social embarrassment or due to
a belief that their condition is just a bad habit
that is untreatable but without treatment, response rates and adults
are low, as low as fourteen percent When diagnosed early
(15:38):
and appropriately treated, However, or more of individuals experienced symptom reduction,
at least in the short term. The evidence base for
psychotherapy for trick tilla mania is small, but suggests that
the use of behavioral therapy is the best habit reversal
is that behavioral therapy and has sometimes included components of
(16:02):
also what's called acceptance and commitment therapy or even dialectical
behavior therapy. These have to do with dealing with the
emotions that surround the behavior that you're doing. Haven't reversal
therapy was first developed about forty years ago by azarn
and None for the treatment of nervous habits and ticks.
(16:25):
Typically HRT is conducted on a weekly basis, but higher
severity of this order might mean more frequent sessions. It's
been shown to benefit many different ways in different numbers
of sessions, anywhere from four to twenty two of usually
an hour. The core aspect of have a reversal is
(16:47):
including self monitoring like asking the patient to track their
hair pulling awareness training what are they feeling as they're
about to pull? Competing response training meaning the behavior you
choose to do that's different, something you'll design with the therapist.
And this combination that is practiced over periods of time
(17:12):
helps to just decrease overall the urge to do it
in the first place. It's been shown to benefit with
the addition of sometimes other therapies. These emotional therapies I
described it should be delivered in person, but now we've
discovered in the pandemic it can be delivered online and
tell atherapy. It remains the first line treatment for this
(17:36):
kind of disorder. In terms of medication, there are currently
no medications that would be universally accepted as the clear
first line, and unfortunately, serotonin reuptake inhibitors, which work for
many things, do not seem to work for this. But
there is something called n acetal systeine or KNACK, which
(18:00):
has demonstrated benefit in a double blind, placebo controlled study
for trick tilamania, using a dose of twelve milligrams twice
a day and giving it approximately nine weeks to work.
The good thing is that NAC has generally very mild
side effects, which maybe involve only some bloated or gassy feelings.
(18:20):
The anti psychotic called a lanzapine, has also been studied
and it also seems to be effective. It, of course, unfortunately,
can have more side effects, for example metabolic syndrome, and
so one should be very careful and judicious and probably
only use it if someone is having a really severe case.
(18:42):
But keep in mind trigger tillomania is a chronic illness
that often results in substantial social dysfunction and can in
rare cases, such as people who eat the hair or
even become so distraught that they have thoughts of suicide,
create life threatening medical problems. Control of hair pulling is
(19:03):
therefore critical for maintaining long term health and quality of life.
So overall, begin with the thorough assessment to establish the
correct diagnosis. Then make sure that this patient doesn't have
any gastro intestinal blockage. If they are a person who
ingests the hair, then you would want to talk to
(19:27):
them about the treatment risks and benefits, and probably begin
habit reversal therapy. I would only consider medication if habit
reversal therapy isn't working on its own. Do you have
a problem I can help with? If so, email me yet.
How can I help? At Seneca women dot Com, All
(19:48):
centers remain anonymous and listen every Friday too. How can
I help with me? Dr Gail's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. The topic of tricotillomania
has been on the minds of many ever since comedian
Amy Schumer revealed she has continued to struggle with it.
So today I am answering a listener's question about her
struggle with hair pulling. Trick tilla mania is a chronic,
(00:50):
repetitive hair pulling disorder, which is an often debilitating psychiatric
condition that's characterized by recurrent pulling out of one's own hair,
leading to hair loss and, as a result, difficulty in
social functioning. Although discussed in the medical literature for over
(01:10):
a century, trick it till a Mania was not officially
included as a mental health disorder in the American Psychiatrics
Association's Diagnostic and Statistical Manual until nine, when it was
classified as an impulse control disorder, but in the most
current edition, trick till a Mania is included in the
(01:31):
chapter on obsessive, compulsive and related disorders with O C
D excoriation disorder, body dysmorphic disorder, and hoarding disorders. The
current criteria for diagnosing trick tolumnia are first are recurrent
pulling out of one's hair resulting in hair loss, also
(01:53):
repeated attempts to decrease or stop hair pulling. The hair
pulling causes lynnely significant distress or impairment in social or
work or other important areas of functioning that the hair
pulling or hair loss is not attributable to another medical
(02:13):
condition like some sort of dermatologic problem, and the hair
pulling is not better explained by the symptoms of another
mental disorder. For example, if you see it's a result
of the person believing that they have a defect or
flaw in their appearance and they need to do this
because that would qualify as body dysmorphic disorder. Nationwide studies
(02:38):
of trichotillomania are actually kind of lacking, but small studies
that examine how common it is among college students, for example,
and another one in terms of adolescence in Israel and
older adults within the community have found that the rates
range from a half a percent to two percent of
the entire population, which actually a fair number of people
(03:03):
in adults. Trick It tell a mania appears to have
a large female preponderance. In fact, it's for women for
everyone man. In childhood, interestingly, it's about equal, but as
you grow up more women suffer than men. And the
behavior hair pulling appears to be quite common and often
(03:27):
presents along a continuum, So from mild to severe. You
may have mild trick it till a mania, but you
could have very severe as well, and when you have
this diagnosis one should really consider treatment. Typically, this disorder
starts at the young age of ten to thirteen, and
(03:50):
this is true no matter which culture or which place
you're located. Pulling the hair can be undertaken at any
botty lee region that has hair. The scalp is the
most common at, but followed by eyebrows at and actually
even pubic hair as common as fifty of people who
(04:13):
struggle with trick A tillomania. Triggers to pull can be sensory,
so in other words, the hair's thickness or length, or
location or physical sensations you have on the scalp might
be a trigger. They could be emotional, so some people
pull because they feel anxious or bored, or tense or angry,
(04:35):
or they could be cognitive, in other words, based on
thoughts about your hair or your parents, or some sort
of misinterpretation of your environment. Many patients report not being
fully aware of their pulling behaviors at least some of
the time. This is known as automatic pulling, as opposed
(04:57):
to focus pulling, would in contrast, occurs when the patient
sees or feels a hair that is just in their
mind not right, or that the hair fills course or
irregular or somehow out of place. People with tricker till
a mania can experience low self esteem and social anxiety
(05:20):
due to their inability to stop pulling and due to
the resulting what's called alopecia or patches of no hair.
People frequently report failure to pursue job advancement or avoiding
of a job interview even because of the pulling. Nearly
a third of adults with trickle till a mania report
(05:41):
a low or very low quality of life, so this
is a disorder that has significant impact, it can result
in unwanted medical consequences. For example, pulling of hair can
lead to skin damage if sharp instruments are used, which
sometimes they are like twee users or scissors. Over of
(06:04):
patients eat the hair after pulling it out, which is
called tricophagia, which can result in gastro intestinal obstruction and
the formation of intestinal hair balls called trichobees ors, requiring
surgical intervention in extreme cases. Although the course of the
illness can vary when untreated, trick at alumnia is commonly
(06:28):
a chronic disorder with fluctuations in intensity over time, but
for the most part, studies have found that the mean
duration of the illness is close to twenty two years.
Individuals report that the symptoms of their pulling, although they
wax and wane in intensity, they do usually persist without treatment.
(06:52):
Now interestingly, most people don't seek treatment. In fact, one
study of a thousand forty eight individuals found that only
thirty nine point five percent had sought treatment from a
therapist and only twenty seven point three sought treatment from
a psychiatrist. One reason for this low rate of treatment
(07:13):
seems to be that the vast majority of individuals with tricotelomania,
as many as eight seven feel that providers don't know
enough about the disorder, which really is not correct. Other
reasons for non treatment can include feelings of shame and embarrassment,
lack of awareness that hair pulling constitutes a recognized medical condition,
(07:37):
and fear of the professional's reaction. Trick Tellomania often occurs
with a variety of other disorders, so major depression, anxiety disorders,
substance use disorders can often occur together with trick Tello mania.
Usually the other disorders started first. Also, many people with
(08:02):
trick till A mania report anxiety and depression due to
the pulling, so that may occur afterwards, so therapists when
they see a patient really need to screen or both
trick atilla mania as well as the secondary manifestation of
the behavior if treatment is going to be successful. Interestingly,
(08:22):
trick tilla mania is often misdiagnosed as obsessive compulsive disorder.
This may partially be because rates of co occurring o
c D are significantly higher in people with trick till
A mania, as high as than those found in the
general community. The repetitive motor symptom of hair pulling share
(08:45):
some similarities with the repetitive compulsive rituals in O c D,
so this raises the possibility of an underlying common neurobiological
pathway for the two disorders. But seven lines of evidence
suggests that trick to le mania is distinct from O
c D. People with trick Telemannia are more likely to
(09:05):
be female, who also report higher rates of repetitive behavior
disorders like skin picking or compulsive neo biding, and are
more likely to have a first degree relative who has
skin picking or neo biding. Compulsions in O c D
are often driven by intrusive thoughts, but by contrast, hair
(09:29):
pulling is rarely driven by those kinds of intrusive thoughts
and it's not part of the diagnostic criteria. Also, while
trick its Lumania symptoms typically start in early adolescence, o
c D usually starts in late adolescence. And in addition,
proof that these disorders are different, treatment approaches should differ.
(09:54):
For example, the exposure and response prevention used for O
c D and how reversal used for trick it tolemania
with ss R eyes saratonin reuptake inhibitor medication showing efficacy
and treating O c D, but not for tricking tilemania.
Trickertlemania does run in families, so sometimes one person in
(10:17):
the family will realize that's what the other person is doing.
And many patients describe feelings of relief in response to
pulling hair, and so it turns out it can be
a way of dealing with negative emotions. So with that,
right after the break, we'll get to my listeners question.
(10:51):
Welcome back. Let's get to my listeners question and see
how can I help Dear Dr Saltz. When where I
wear mascara, I find myself scraping it off over the
course of the day and at the same time pulling
out some eyelashes. I find it hard to resist doing this,
(11:12):
and because I've pulled out some eyelashes, I feel like
I need the mascara even more to fill in more
thin or bare areas around my eyes. But then I'm
caught in this vicious loop of pulling on the mascara
lashes and losing more and more lashes. This has been
a problem off and on since I'm a teenager, but
(11:32):
it's really bothering me. What can I do to stop
pulling out eyelashes is actually a symptom of trigotillomania. That
you have recurrently had this problem since your teens and
can't really stop heightens the concern that this is indeed trigotillomania.
(11:53):
Trigotillomania is not only pulling out hair on the head.
It can be any hair anywhere, and eyebrows, eyelashes, and
even pubic hair are not uncommon. Even if any one
of these areas is the only place that you pull,
that you tend to pull mostly when there is mascara
on your lashes may simply mean that mascara, which has
(12:16):
a rough and thick feeling to it to the touch
on your lashes, is serving as a trigger to make
you want to pull more. Like other picking disorders, there
is often a component of feeling a need to make
things smooth or unblemished in some way, and trying to
pull off the mascara and subsequently the lash may have
(12:38):
to do with the feeling that you need to remove
any roughness and get the hair just right, so to speak.
Given that this has been with you a long time,
it may be that you cannot stop this on your own,
but you can first try I would suggest you need
to stop wearing mascara if it's a clear trigger, which
(13:01):
it sounds like it is. Avoiding the trigger will allow
you to decrease and possibly stop the behavior. Try using
an eye pencil to draw a line to fill in
around your eyes. Maybe not quite as good, but some
method of accomplishing what you want while still not using mascara.
(13:23):
Do not have anything coding your remaining lashes. If you
are able to not touch your eyes with no masscara,
then you may be able to allow your lashes to
grow in and not be a messk era user going forward,
because it will probably always be a trigger. Remembering trigger
(13:44):
to la mania is a chronic disorder, but in this instance,
be on the lookout for pulling hair in another location
because sometimes it can move areas. If this doesn't work, though,
you should see a professional who eats this disorder. Most typically,
you will start with what is called habit reversal training.
(14:07):
This helps you to queue into what triggers you to
start pulling, what feeling happens just before you do pull,
and then in recognizing it, you want to develop what's
called a competing behavior, which is another behavior that in
some ways is like the opposite of the pulling, so,
(14:27):
for example, clenching your fists in your lap so you
essentially can't pull. You practice doing this actively for thirty
minutes to an hour per day under the guidance of
the professional. Over time, the pulling diminishes. Some people do
need medication if the severity is such that habit reversal
(14:50):
alone doesn't work, I would advise you to get treatment soon,
because the longer this goes on, the harder it is
to stop, and the more effect it has on your life.
Treatment is time limited and often quite effective. I hope
that was helpful. As I mentioned earlier, individuals with trichotillomania
(15:15):
rarely seek psychological or psychiatric treatment for their condition. Patients
avoid seeking treatment due to social embarrassment or due to
a belief that their condition is just a bad habit
that is untreatable but without treatment, response rates and adults
are low, as low as fourteen percent When diagnosed early
(15:38):
and appropriately treated, However, or more of individuals experienced symptom reduction,
at least in the short term. The evidence base for
psychotherapy for trick tilla mania is small, but suggests that
the use of behavioral therapy is the best habit reversal
is that behavioral therapy and has sometimes included components of
(16:02):
also what's called acceptance and commitment therapy or even dialectical
behavior therapy. These have to do with dealing with the
emotions that surround the behavior that you're doing. Haven't reversal
therapy was first developed about forty years ago by azarn
and None for the treatment of nervous habits and ticks.
(16:25):
Typically HRT is conducted on a weekly basis, but higher
severity of this order might mean more frequent sessions. It's
been shown to benefit many different ways in different numbers
of sessions, anywhere from four to twenty two of usually
an hour. The core aspect of have a reversal is
(16:47):
including self monitoring like asking the patient to track their
hair pulling awareness training what are they feeling as they're
about to pull? Competing response training meaning the behavior you
choose to do that's different, something you'll design with the therapist.
And this combination that is practiced over periods of time
(17:12):
helps to just decrease overall the urge to do it
in the first place. It's been shown to benefit with
the addition of sometimes other therapies. These emotional therapies I
described it should be delivered in person, but now we've
discovered in the pandemic it can be delivered online and
tell atherapy. It remains the first line treatment for this
(17:36):
kind of disorder. In terms of medication, there are currently
no medications that would be universally accepted as the clear
first line, and unfortunately, serotonin reuptake inhibitors, which work for
many things, do not seem to work for this. But
there is something called n acetal systeine or KNACK, which
(18:00):
has demonstrated benefit in a double blind, placebo controlled study
for trick tilamania, using a dose of twelve milligrams twice
a day and giving it approximately nine weeks to work.
The good thing is that NAC has generally very mild
side effects, which maybe involve only some bloated or gassy feelings.
(18:20):
The anti psychotic called a lanzapine, has also been studied
and it also seems to be effective. It, of course, unfortunately,
can have more side effects, for example metabolic syndrome, and
so one should be very careful and judicious and probably
only use it if someone is having a really severe case.
(18:42):
But keep in mind trigger tillomania is a chronic illness
that often results in substantial social dysfunction and can in
rare cases, such as people who eat the hair or
even become so distraught that they have thoughts of suicide,
create life threatening medical problems. Control of hair pulling is
(19:03):
therefore critical for maintaining long term health and quality of life.
So overall, begin with the thorough assessment to establish the
correct diagnosis. Then make sure that this patient doesn't have
any gastro intestinal blockage. If they are a person who
ingests the hair, then you would want to talk to
(19:27):
them about the treatment risks and benefits, and probably begin
habit reversal therapy. I would only consider medication if habit
reversal therapy isn't working on its own. Do you have
a problem I can help with? If so, email me yet.
How can I help? At Seneca women dot Com, All
(19:48):
centers remain anonymous and listen every Friday too. How can
I help with me? Dr Gail's Salts
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