Lesson 1: Clinical Disorders - Part A

Description

A young woman sought treatment at a dermatology clinic for her increasing baldness at the crown of her scalp. The clinician did not find any disease relating to a dermatological cause, so the 25 year-old was referred to a psychiatrist. She told the psychiatrist that, since she was a child, she pulled out single hairs from the top of her head after twisting the strand of hair around her finger.

She generally performed the behaviour when alone, tired, bored, or reflecting over a stressful event.

After pulling the single hair from her scalp, she would inspect it and run it over her lips. She would continue this behaviour for several minutes at a time. The plucking of the hair did not hurt – in fact, it produced a sense of release. The woman hid her “thinning” hair by wearing it up, but eventually the baldness was too difficult to hide. She sought help when she realized that she may have to wear a wig.

The woman also spoke of temper problems, drinking too much, and having unsatisfying relationships. Other than linking her hair-pulling to the childhood absences of her mother, she described no other causal link or health problem. As her treatment sessions progressed, it was learned that the patient had experienced many traumatic events as a child. For example, her father (who was a barber) died from cancer. The patient described herself as clean and orderly, but noted that she smoked a pack of cigarettes per day. She also admitted to experimenting with drugs such as speed and marijuana, but because they made her paranoid, she discontinued their use.

Diagnosis

While stroking and fussing with hair is a common practice for many people, in this case the behaviour of hair pulling increased to the point of alopecia (baldness). The patient was unable to control the desire to pull out her hair, and she experienced a sense of relief from the action. Because no dermatological reason is apparent for the hair loss, these symptoms are sufficient for a trichotillomania diagnosis. Although not in this case, this disorder often begins in childhood and is frequently connected with intellectual disorders (mental retardation).

Her DSM diagnosis is Axis I: trichotillomania.