Pediatric Trichotillomania: Clinical Presentation, Treatment, and Implications for Nursing Professionals1
Section snippets
Epidemiology
Pediatric TTM is estimated to have a point prevalence of approximately 0.5% (Hamdan-Allen, 1991) and a lifetime prevalence of 0.6%–3.4% in adults, most of whom began pulling as children (>85%; Bruce et al., 2005, Christenson et al., 1991). The disorder is up to seven times more common in children than in adults (Bruce et al., 2005, Dean et al., 1992, Hamdan-Allen, 1991, Tay et al., 2004) and typically has its age of onset either in preschool or in the preadolescent years (Christenson et al.,
Definition
TTM is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) of the American Psychiatric Association (2000) as an impulse control disorder, similar to kleptomania, pyromania, or compulsive skin picking. The DSM-IV-TR requires five criteria for the disorder to be diagnosed: (a) one intentionally and repetitively pulls out his or her hair, resulting in noticeable hair loss; (b) an increasing sense of tension occurs immediately before or
Clinical Presentation
TTM is characterized by the non-cosmetic, repetitive pulling of hair from any part of one's body, resulting in noticeable hair loss. Hair pulling behavior occurs along a continuum, ranging from a relatively benign form that produces no significant aesthetic or psychological distress to a more serious disorder that is often disfiguring and leads to great personal suffering. Hair is most commonly pulled from the crown, occipital, or parietal regions of the scalp (Papadopoulos et al., 2003) but
Psychosocial and Physical Complications
Regardless of the age of the child, TTM can result in considerable distress for both the child and the family. Youth with TTM can spend upwards of 30–60 minutes per day pulling hair and experience significant distress regarding their symptoms (Tolin et al., 2007). Children may feel ashamed, guilty, anxious, or depressed over their pulling behavior (Bruce et al., 2005). Bald spots may adversely affect body image, and concerns over appearance and perceived lack of willpower may lead to low
How to Recognize TTM in Your Patients
Because TTM is a problem of considerable morbidity in pediatric populations, it would be most beneficial for affected children if their difficulties could be identified soon after onset, before the condition becomes chronic and increasingly impairing. When a child admits to pulling or their parents have witnessed hair pulling behavior, it is relatively easy to diagnose TTM. However, because pulling can occur outside of a child's awareness or away from a parent's notice, how can nurses recognize
Treatment
Depending on the age of the child, several treatment options are available to combat TTM. Simple home remedies, such as placing band-aids on the child's fingers, socks over the child's hands, or a hat on the child's head, may reduce the behavior in some children. However, for those in whom the behavior is more entrenched, behavior modification programs implemented by a behavior therapist or psychologist show the most success (Sah et al., 2008). For very young children with mild TTM, behavior
Implications for Nurses
Considering that nurses interact with children in multiple settings (e.g., school, primary care, hospitals, home visitations) and may be the professionals who spend the greatest amount of time with child patients, nurses may be the persons most equipped to recognize TTM. Care of patients who may present with TTM should be guided by a systematic process of assessment and intervention. Within this framework, it is of utmost importance to establish a calm and safe therapeutic environment in which
Conclusion
TTM adversely affects thousands of children, resulting in seriously negative physical and psychosocial consequences. These children and their parents may not be aware of the cause of their affliction or may feel helpless to change their pulling behavior. As pediatric nurses spend the greatest amount of time with their child patients, they may be one of the first persons able to identify TTM. It is therefore of the utmost importance for nurses to be aware of this condition, to recognize the
References (55)
- et al.
Habit-reversal: A method of eliminating nervous habits and tics
Behavioral Research and Therapy
(1973) - et al.
The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample
Journal of Behavior Therapy and Experential Psychiatry
(2004) - et al.
Systematic review: Pharmacological and behavioral treatment for trichotillomania
Biological Psychiatry
(2007) - et al.
Adult men and women with trichotillomania
Psychosomatics
(1994) - et al.
Pathological hair pulling: A review of the literature and case reports
Comprehensive Psychiatry
(1992) - et al.
Affective correlates of trichotillomania
Behaviour Research and Therapy
(2002) - et al.
Characteristics and phenomenology of hair-pulling: An exploration of subtypes
Comprehensive Psychiatry
(2001) - et al.
Childhood trichotillomania: Clinical phenomenology, comorbidity, and family genetics
Journal of the American Academy of Child and Adolescent Psychiatry
(1995) - et al.
An epidemiological study of trichotillomania in Israeli adolescents
Journal of the American Academy of Child and Adolescent Psychiatry
(1995) Trichotillomania
Dermatologic Clinics
(1987)
Trichotillomania: A histopathologic study in sixty-six patients
Journal of the American Academy of Dermatology
Clinical characteristics and psychiatric comorbidity in children with trichotillomania
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive behavioral treatment of trichotillomania in youth: What went right and what went wrong?
Cognitive and Behavioral Practice
Broadening the approach to treatment of trichotillomania in youth
Cognitive and Behavioral Practice
Personal toll of trichotillomania: Behavioral and interpersonal sequelae
Journal of Anxiety Disorders
Trichotillomania: An obsessive compulsive disorder?
Psychiatric Clinics of North America
Diagnostic and statistical manual of mental disorders
Tweede Nationale Studie Naar Ziekten en Verrichtingen in de Huisartspraktijk
A simplified behavioral treatment for trichotillomania: Report of two cases
Pediatrics
Negative peer evaluation in adolescents: Effects of tic disorders and trichotillomania
Child and Family Behavior Therapy
Diagnosis and management of trichotillomania in children and adolescents
Pediatric Drugs
Treatment of early onset hair pulling as a simple habit
Behavior Modification
Trichotillomania—From prevalence to comorbidity
Psychiatric Times
The characterization and treatment of trichotillomania
Journal of Clinical Psychiatry
Characteristics of 60 adult chronic hair pullers
American Journal of Psychiatry
Clinical profile, comorbidity, and treatment history in 123 hair pullers: A survey study
Journal of Clinical Psychiatry
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