Obsessive-Compulsive and Related Disorders II

Trichotillomania is a mental illness that presents as repeated and uncontrollable urges to pull out body hair. It is one of a group of behaviors known as “body-focused repetitive self-grooming behaviors” in which individuals pull, pick, scrape, or bite their hair, skin, or nails, resulting in damage to the body. The onset of hair pulling most often coincides with or follows, the onset of puberty. Among children, females and males are more equally represented. The course of the disease is chronic, though individuals can experience symptoms that wax and wane over time. The exact cause of Trichotillomania still remains largely unknown.

Those diagnosed with Trichotillomania feel compelled to pull out body hairs. The common tendency is to pull out hair from scalp, eyebrows, eyelids, or elsewhere, resulting in hair loss and other forms of impairment and leaving bare patches on areas where hair has been pulled out. Less common areas include facial, pubic, and peri-rectal regions. Pulling usually occurs in private.

Obsessive-Compulsive Excoriation Disorder or Dermatillomania is part of a group of behaviors known as “body-focused repetitive self-grooming behaviors (BFRBs)”. Currently classified as an Obsessive-Compulsive Disorder, the exact cause of Excoriation Disorder or Dermatillomania is unknown. The behavior typically begins in early adolescence, although skin picking disorder can begin at any age. As many as 3.8 percent of college students are believed to exhibit symptoms of excoriation. Without treatment, skin picking disorder tends to be a chronic condition that may wax and wane over time.

The face is predominantly involved, followed by the extremities and scalp. There is often a primary site of skin picking, but the skin picking is sometimes shifted to allow an injured area to heal. Although the severity of excoriation disorder varies greatly, many people who struggle with skin picking exhibit noticeable skin damage, which they attempt to camouflage with makeup, clothing, or other means of concealing affected areas. Due to shame and embarrassment, individuals may also engage in avoidance behaviors, including the avoidance of certain situations that may lead them to feel vulnerable about being “discovered” (e.g., not wearing shorts, not being seen by others without makeup, avoiding intimacy).

The Substances Induced category may be utilized when symptoms are exhibited during or soon after intoxication or withdrawal or after exposure to a medication. The involved substance/medication is capable of producing the symptoms and the disturbance is not better explained by an Obsessive-Compulsive and Related Disorder that is not substance/medication-induced. Repetitive, intrusive thoughts and compulsive behaviors associated with Obsessive-Compulsive and Other Disorders are known to be a result of exposure to a long list of medications and substances. Common contributors include:

• Amphetamines 
• Antipsychotics 
• Hypnotics 
• Sympathomimetics such as epinephrine or norepinephrine and other bronchodilators
• Anticholinergics
• Anticonvulsants 
• Thyroid medications
• Lithium (lithium carbonate) 
• Cocaine, including crack and crystal methamphetamine
• Hallucinogens (LSD, mescaline, psilocybin mushrooms)
• Phencyclidine (PCP)

Compulsive Disorder Due to Medical Condition Obsessive can be linked with some Medical Conditions that can cause symptoms seen in the Obsessive-Compulsive and Related Disorder spectrum. These can include excoriation (compulsive skin picking) and trichotillomania (compulsive hair-pulling) and develop due to due to organic illnesses. These may include:

• Anemia, which can lead to poor circulation and poor oxygenation of extremities, causing itching sensations
• Liver disease
• Uremia or kidney failure
• Allergic reactions causing a rash
• Acne vulgaris
• Other skin conditions.

Trichotillomania or compulsive hair pulling can develop due to a number of medical illnesses or conditions, such as:

• Fungal infection such as Tinea capitis or ringworm
• Scalp acne
• Psoriasis
• Seborrheic dermatitis
• Other scalp conditions

Other medical conditions can also cause symptoms of Obsessive-Compulsive Disorder. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) is an example. Symptoms may include:

• Sudden onset of OCD in a formerly happy, social, athletic, and well-adjusted child
• Changes with eating
• Intense sensory issues with textures, sound, and light
• ADHD
• Sudden onset of severe anxiety associated with OCD and panic attacks
• Severe separation anxiety
• Intense fear of germs and contamination associated with pure OCD