Trichotillomania :: Trichotillomania or Tricholomania

We’ve all heard that you can’t judge a book by its cover, and that is certainly true of Trichotillomania. The Medusa-like figure on the jacket suggests that patients with trichotillomania are evil, mythical creatures, rather than real people with a troublesome disorder. Fortunately, the authors are well aware of the difficulties faced by these patients; they do a superb job of characterizing the clinical aspects of the disorder and providing a careful review of its pathophysiologic features and treatment. Francois Hallopeau, a French dermatologist, coined the term trichotillomania by combining the Greek words trichos (meaning hair), tillein (meaning to pull), and mania (meaning madness, or an abnormal penchant or morbid impulse). Although mania has since come to be regarded as a form of psychosis, the term accurately describes the compulsive nature of hair pulling.

The authors review the many ways in which trichotillomania can be manifested, information that is vital to all health practitioners, since women with trichotillomania (90 percent of patients are female) typically suffer in silence rather than admit that their bald spots or lack of eyelashes are the result of their own hair pulling.

After a comprehensive presentation of the clinical features of trichotillomania in children and adults, the authors review the neurobiologic underpinnings of the condition, including theories of specific regional dysfunction and possible neurotransmitter abnormalities. Animal models are introduced as a means of suggesting new avenues of research. Moon-Fanelli, Dodman, and O’Sullivan suggest parallels between trichotillomania and aberrant self-grooming. This chapter is intriguing but would be more interesting to the general reader if the authors had provided commentary and critique. For example, why is allogrooming the equivalent of trichotillomania when nonspecific displacement reactions (including grooming behavior, among others) are more reliably exacerbated by environmental sources of stress (as is the case with trichotillomania)?

The greatest strength of Trichotillomania is the section on treatment. The editors sought out the world’s experts on pharmacologic, behavioral, hypnotic, and psychotherapeutic treatments for trichotillomania. Each of these experts gives a clear, concise description of the methods used in the treatment of compulsive hair pulling. They also provide a realistic assessment of the risks and benefits of the therapies, thus allowing clinicians to offer their patients the best treatment options. Since most patients with trichotillomania require combination therapy (e.g., cognitive behavior therapy and selective serotonin-reuptake inhibitors), practitioners will appreciate that specific guidelines are presented for multimodal therapies. Given the fact that 1 percent of Americans have trichotillomania, every health care professional should read this clear, concise guidebook.

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