Trichotillomania and Excoriation Disorder

To conclude our journey through Obsessive-Compulsive and Related Disorders, let's discuss two disorders where the compulsion is directed towards oneself: Trichotillomania (hair-pulling disorder) and Excoriation Disorder (skin-picking disorder). I'll try to explain them in my own words.

In Trichotillomania, individuals repeatedly pull out their hair, which can lead to noticeable hair loss. This behavior is often accompanied by specific rituals, such as selecting particular hairs to pull. The process may involve examining the hair after pulling it, touching it, or even placing it on the lips. Some individuals may chew or ingest the hair.

Hair-pulling can be done with fingers or with tools like tweezers. These rituals are generally not painful and can be performed for hours each day. The consequences of these behaviors include bald patches or areas with significantly reduced hair, which individuals often try to hide.

In Excoriation Disorder (Skin-Picking Disorder), individuals repeatedly pick at their skin, leading to skin lesions. Similar to Trichotillomania, this behavior may involve rituals, such as choosing specific areas of skin or scabs to pick. The process may include examining the picked skin, touching it, or even ingesting it.

Both disorders often arise in response to a perceived bodily irregularity or defect, triggering anxiety. The act of hair-pulling or skin-picking provides a sense of relief or gratification, which reinforces the behavior. The pressure to engage in these behaviors is so strong that attempts to stop are often unsuccessful, and symptoms can persist for months or years.

Trichotillomania (DSM-5):

• Recurrent pulling out of one's hair, resulting in hair loss.
• Repeated attempts to decrease or stop the behavior.
• The behavior is not better explained by another mental disorder.

Excoriation Disorder (DSM-5):

• Recurrent skin picking, resulting in skin lesions.
• Repeated attempts to decrease or stop the behavior.
• The behavior is not better explained by another mental disorder.

Sources:

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

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