Abstract

This paper addresses the relationship between trichotillomania and anorexia nervosa through the exploration of four peer-reviewed articles that expand on the obsessive-compulsive spectrum. Zucker, et al. (2011) suggest that the presence of an eating disorder would significantly increase the risk of developing trichotillomania. Other articles expand on the etiology of the disorders and the similarities that cause this correlation. This paper utilizes the research brought forth by Zucker, et al. (2011) in conjunction with the three other articles to encourage further research upon the assumed positive correlation between trichotillomania and anorexia nervosa.

Keywords: trichotillomania; anorexia nervosa; obsessive-compulsive disorder; eating disorders; repetitive behaviors; hair pulling; impulsivity; OCD; psychiatric comorbidity

Introduction

Is there a correlation between the repetitive pulling of one’s hair and the repetitive restriction of one’s caloric intake? Trichotillomania and anorexia nervosa are both mental disorders that fall on the obsessive-compulsive spectrum. Trichotillomania causes a person to pull out body hairs repetitively. Anorexia nervosa causes a person to monitor their caloric intake in extreme manners continuously. Since both disorders share a common repetitive cycle, it would be reasonable to assume that having one disorder could increase the risk of developing the other. This paper will begin by discussing trichotillomania and anorexia nervosa as individual mental health disorders. Then, this paper will go on to examine findings that support how the similarities between the two disorders result in a positive correlation between the two obsessive-compulsive disorders.

Discussion

Trichotillomania (TTM), a mental disorder that falls on the obsessive-compulsive spectrum, is characterized by recurring events of impulsive body hair removal (Grzesiak, Reich, Szepietowski, Hadrys, & Pacan, 2017). This hair removal is executed using diverse methods and in varying locations. For example, while most people with trichotillomania will pull using their fingers, others will opt to use tweezers, scissors, or other self-mutilating methods to dislodge the hair follicle. The most common sites for pulling include the scalp, eyelashes, eyebrows, and the pubic area (Grzesiak, et al., 2017). There are also two different types of trichotillomania. For some, the urge to pull hair comes automatically, meaning that the person will not even realize they are pulling until the episode is over. For others, the behavior is focused, resulting in complete awareness of the behavior but inadequate willpower or control to stop it. No matter the type of trichotillomania, the consequences remain the same. In acute trichotillomania, which usually affects adolescent girls, hair loss is usually temporary, and the behavior is eventually dropped as they move into young adulthood. However, in chronic trichotillomania, the repetitive pulling of hair from the same area leads to follicle damage and even permanent hair loss (Grzesiak, et al., 2017). This hair loss, temporary or permanent, is extremely stressful and can lead to a plethora of other comorbidities. In fact, psychiatric comorbidity in trichotillomania is a common occurrence. Anxiety disorders, depression, substance abuse, eating disorders, and poor body image are just a few to name (Siddiqui, Ram, Munda, Siddiqui, & Sarkhel, 2018). ). All of these comorbidities signify that mental illnesses usually accompany one another. In the case of trichotillomania, this provides proof that there is a likely correlation to other disorders such as anorexia nervosa.

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To diagnose trichotillomania, five conditions must be met. First of all, the repetitive pulling of one’s hair should result in hair loss that is noticeable. Second, the patient must sense increasing tension before pulling the hair or resisting the urge to pull the hair. After pulling the hair, the patient should experience euphoric feelings. These feelings should mainly be pleasure, satisfaction, or relief. The behavior should not be a result of a different psychological disorder. Finally, the consequences of the behavior should cause damage significant enough to address and overcome (American Psychiatric Association, 2013). This strict protocol that is set in place for the diagnosis of trichotillomania ensures that symptoms are taken to account in the most appropriate manner.

Anorexia nervosa is also a mental disorder that falls on the obsessive-compulsive spectrum. Anorexia nervosa is characterized by an obsessive desire to achieve a sense of control over caloric intake (Atalaya, 2018). This obsession will then lead to a restriction of calories that lead to drastic weight loss. In order to restrict calories, one might over-exercise, under eat, take laxatives, or use varying combinations of methods. When this behavior is exhibited in short bursts, one may experience what is known as atypical anorexia. This is basically when a person exhibits all the signs and symptoms of anorexia nervosa but hasn’t experienced drastic and dangerous weight loss. When the behavior is extended over a long period, however, the consequences become severe. The physical consequences include fatigue, thinning hair, halitosis, impaired immune functioning, and dizziness. The mental consequences include social anxiety, depression, body dysmorphia, personality disorders, and more (Atalaya, 2018). Again, like trichotillomania, the consequences of anorexia nervosa reveal that psychiatric comorbidity is extremely common.

According to the American Psychiatric Association (2013), a proper diagnosis for anorexia nervosa follows three main criteria. First, there must be a deficit in caloric intake which leads to abnormally low body weight for the patient based on height, age, and sex. Second, the patient must undergo an irrational fear of weight gain, despite being malnourished. Third, the patient’s perception of their body image must be distorted; they are unable to realize that they are severely underweight or unshapely.

It is evident that the two disorders, trichotillomania and anorexia nervosa, are incredibly similar to one another. Because of this, the possibility of a correlation between trichotillomania and anorexia nervosa is logical to assume. Research done on relationships between obsessive-compulsive disorders state that the underlying similarities between several different OCDs can cause them to influence the development of another (Siddiqui, et al., 2018). In a study with 69 participants that already had an eating disorder, over 50% of the participants admitted to engaging in hair-pulling behavior (Zucker, et al., 2011). The similarities between the two disorders, such as the repetitive nature of the behavior and the high possibility for psychiatric comorbidity, contribute to this correlation. Other factors, such as diagnostic validators and mental consequences, also cause these disorders to share a close relationship with each other (American Psychiatric Association, 2013). The majority of the limited research done on this relationship points to a strong correlation between obsessive-compulsive disorders like trichotillomania and anorexia nervosa.

Focusing on a study by Zucker, et al. (2011), the significance of trichotillomania among people with eating disorders is evident through a positive correlation. This positive correlation is derived from the idea that obsessive-compulsive behavior is directly proportional to high rates of comorbidity. (Siddiqui, et al., 2018).  In this case, trichotillomania and anorexia nervosa are both mental disorders that fall on the obsessive-compulsive spectrum. In accordance to the studies by Zucker, et al. (2011) and Siddiqui, et al. (2018), it is safe to say that there are high rates of comorbidity in trichotillomania and anorexia nervosa. This would then translate to the assumption that the two disorders are related to each other and share a positive correlation.

Conclusion

In summary, this paper calls to attention the various characteristics of trichotillomania, anorexia nervosa, and how their characteristics could signify a relationship between the two obsessive-compulsive disorders. Based on the research gathered, it is logical to assume that the presence of one obsessive-compulsive disorder leads to an increased risk of developing another obsessive-compulsive disorder. This is due to the sharing of underlying ritualistic behaviors that exist among those disorders that fall on the obsessive-compulsive spectrum. Some limitations to this research include lack of concrete support from similar articles. Thus, further research should be conducted to strengthen the assumption that there is a positive correlation between trichotillomania and anorexia nervosa.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Atalayer, D. (2018). Structural and Functional Neural Correlates of Anorexia Nervosa. Current Approaches in Psychiatry / Psikiyatride Guncel Yaklasimlar, 10(3), 348–374. https://doi.org/10.18863/pgy.355513

Grzesiak, M., Reich, A., Szepietowski, J.C., Hadrys, T., & Pacan, P. (2017). Trichotillomania Among Young Adults: Prevalence and Comorbidity. Acta Dermato-Venereologica, 97(4), 509–512. https://doi.org/10.2340/00015555-2565

Siddiqui, M., Ram, D., Munda, S., Siddiqui, S., & Sarkhel, S. (2018). Prevalence of obsessive-compulsive spectrum disorders in obsessive-compulsive disorder. Indian Journal of Psychological Medicine, 40(3), 225–231. https://doi.org/10.4103/IJPSYM.IJPSYMpass:[_]556_17

Zucker, N., Von Holle, A., Thornton, L. M., Strober, M., Plotnicov, K., Klump, K. L., … Kaye, W. H. (2011). The significance of repetitive hair-pulling behaviors in eating disorders. Journal of Clinical Psychology, 67(4), 391–403. https://doi.org/10.1002/jclp.20770