Trichotillomania is described as the recurrent pulling out of one’s own hair, leading to alone is and marked impairment. It is included under the OCD type disorders in the DSM-V. The other disorders now in that category include body dysmorphic disorder, hoarding disorder, excoriation disorder, and OCD. The lifetime prevalence is estimated at around .6% with a  F:M ratio of 4:1. The typical age of onset is between 10-13 years. The pulling can be automatic or focused. Over 20% of patients also experience trichophagia. Only 1/3 of patients with the disorder seek treatment. The disease is highly comorbidies with other psychiatric disorders, particularly those in the. OCD spectrum. Stimulants can make the pulling worse. It is also associated with rare variations in the SAPAP3 gene and does show a familial pattern. Treatments include psychotherapy, usually behavioral using habit reversal techniques (self monitoring, awareness training, competing response training, and stimulus control procedures) and pharmacotherapy (clomping mine, antipsychotic medications, and glutamate rigs agents). Among the glutamatergic agents, N-acetyl cysteine (NAC) has demonstrated benefit in a double blind PC trial…at a dosage of 200 mg. twice a day. Other agents worth noting include  olanzapine.  SSRIS have not yet shown to be that effective, adn fluvoxamine may be the drug of choice. 

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