Analysis of Trichotillomania and Depression
PSYC 8012 - Psychopathology
University of Cincinnati
In the initial call Suzanne discusses her child in which Growing up
Suzanne’s parents made her feel like she was not doing good enough,
they would ask “why don’t you have boyfriend?” (Gorenstein &
Comer, 2015, pg. 297). With not recalling how it started but
remembering that it would relax her whenever she felt tense. Suzanne
had the idea that both of her eyelashes and eyes were really irritated
also, initiating that she had some dirt in there and it was stuck between
her eyelashes. Therefore, Suzanne would loosen it and stop the
irritation by pulling the eyelash out, Suzanne stated that “the little
pain of pulling the lash out was something I actually looked forward
to, it’s like when you have a hanging fingernail that hurts and you
need to pull it out: a second of pain and instant relief” (Gorenstein
&Comer, 2015, pg.298). Once she had noticed that she was doing it,
she was thinking to herself that she should not pull out an eyelash.
Once that was over, there was an immediate relief, before you know
it, Suzanne’s eyelids were running out of hair, At first Suzanne
believed that it was not a big deal only because no one around her had
noticed, Suzanne initially thought she was just plucking the ones that
irritated her the most. One night while at dinner Suzanne’s mother had
noticed something odd about her daughter, shocked at what she
discovered she urged Suzanne to stop on a good her lashes did grow
back, and the eyelids weren’t as irritated all the time. After about 6
months, she didn’t even have to think about it anymore.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
Suzanne soon began to pull hair from her scalp after about two months
she felt a patch of skin exposed; feeling embarrassed she did not let
anyone to see a bald patch not even her parents. However, that did not
go to well with her mother who was furious and feeling even more
down about it. Suzanne will be graduating this coming spring she has
not pulled out any hairs for 4 months both of her parents are happy,
Suzanne even started dating a guy named Mark, all in all life is good
for her however she is wondering if she ever feels anxious or nervous
will she resort back to pulling her hair out.
A psychiatric disorder is defined as a “mental illness diagnosed by a
mental health professional that greatly disturbs your thinking, moods
and/or behavior and seriously increases your risk of disability, pain,
death or loss of freedom” ( Salters-Pedneault, 2020). Suzanne and her
mother, Sherry are seeking help for preventing Trichotillomania,
however, further evaluation would need to be done in determining if
other disorders is a contributing factor.
Before treating the disorder(s), a diagnosis would need to be
determined. In order for a diagnosis to be determined, the patients’
past experiences ( i.e., childhood, relationships, trauma, etc.,) would
need to be examined. In the following case of Suzanne, a young
woman who begins an initial call to the helpline for obsessive-
compulsive and anxiety disorders; so, the fact that Suzanne is reaching
out to someone already shows that she has a problem. Now, Suzanne
begins off by saying "I don’t know when I started doing it"
(Gorenstein & Comer, 2015, pg. 297). When determining a diagnosis,
the symptoms would have to first be examined, and Suzanne
displayed symptoms of trichotillomania. Even before she had started
college Suzanne discussed how she was nervous about things, what
those things were is unclear however, she did say that she always
hated school though that may play a role but is not a contributing
factor. Suzanne states " the more nervous I became, the tighter I
pulled” (Gorenstein & Comer, 2015). Suzanne’s childhood was good
however, she felt like she was not doing enough for her parents,
describing her parents as ‘difficult’, Psychoanalyst theorist Sigmund
Freud suggested the “three levels of consciousness , comparing the
mind to an iceberg floating in the water, like an iceberg, only a small
part of the mind is readily seen”(Cloninger, 2013). What this means is
that Suzanne is recalling one aspect of her childhood in which her
relationship with her parents can contribute to her diagnosis.
It appears that when Suzanne is faced with stressful situations, she
often pulls out hairs from her eyelashes later on’ she would go from
pulling hair from her eyelashes to pulling hair from her scalp.
Conducting research on Depression this is from HelpGuide.org, the
following symptoms that fit this scenario included: sleep changes for
Suzanne she mentioned " After my victory over eyelash plucking, I
found myself trying to cope with school and other stresses in other
ways, throughout high school, I bit my nails and often stayed up all
night worrying myself to the point of tears, and walking around with a
headache, half asleep" (Gorenstein &Comer, 2015, p.298). So, that
was the first indication that she may had depression, however,
researching even further. Another symptom of depression includes
self-loathing and feelings of helplessness or hopelessness. In the
beginning, Suzanne describes the relationship with her parents. She
described how they would make her feel like she was not doing
enough. then with her hair pulling she stated that " One night at
dinner, my mom just turned to me after we’d been sitting together the
whole dinner, and screamed out, what happened to your eyelashes?
That was so embarrassing! I wanted my parents to just go away, they
wouldn’t understand why I had to do it. I just wanted to crawl into a
hole and die”( Gorenstein&Comer, 2015, p.298). Based on the
criteria in the DSM-5 library, anxious distress is defined as the
“presence of at least three of the following symptoms during the
majority of days of a major depressive episode or persistent depressive
disorder [ dysthymia]” (First, 2013). The three symptoms Suzanne
displayed were one, tense feelings Suzanne stated that “When I was in
the seventh grade I used to pluck out my eyelashes I can’t remember
how it started but, I remember it used to relax me when I was tense”
(Gorenstein& Comer, 2015, pg.297). Reading the scenario and how
often Suzanne would pluck hair from her eyelashes and scalp it is safe
to say that she got tense quite often. Another symptom Suzanne had
faced nights of restlessness stating that “throughout high school I bit
my nails and often stayed up all night worrying myself to the point of
tears and walking around with a headache, half-asleep during the day”
( Goreinstein &Comer, 2015, pg. 298). The last symptom Suzanne
displayed was fearful of something may happen “But I do wonder
whether I am prone to pulling my hair, will I revert to this whenever I
face a crisis? That worries me, and for now that’s why I am continued
to attend therapy” (Gorenstein & Comer, 2015,pg. 301). With that
being said, Suzanne would be diagnosed with moderate depressive
disorder with anxious distress. This particular DSM was chosen over
the others because this diagnostic manual breaks down the different
criteria for a diagnosis.
Suzanne has the ideal of being happy however, no matter what she
does it appears not to be good enough in the eyes of parents which
results in Suzanne of not being in a good space emotional/ mentally
wise. Therefore, this is the reasoning of her seeking help to be able to
feel happy again. Psychoanalyst theorist Sigmund Freud suggested the
“three levels of consciousness, comparing the mind to an iceberg
floating in the water, like an iceberg, only a small part of the mind is
readily seen”(Cloninger, 2013). Suzanne is aware that she has a
challenge when it comes to hairpulling therefore, she is seeking help
to see if she is prone to having trichotillomania. Carl Rogers
[humanistic theorist], observed that people have conflict in terms of
the ideal and real self, Suzanne is in conflict with on what makes her
happy for her sake or attempting to be happy just to please her parents.
Keep in mind that trichotillomania can occur in anyone no matter the
gender, age, sexual orientation, socioeconomic status, race, ethnicity,
and religion. Hair pulling was first documented Aristotle in the 4th
Century BC “in his renowned philosophical work “Nicomachean
Ethics in the Book VII, Continence and Incontinence: Pleasure, he
discusses self-control, vices, and brutishness” ( Waas &Yesudian,
2018). For this diagnosis an appropriate theoretical orientation that
would best fit this scenario is Alfred Adler’s theory, striving from
inferiority to superiority “ the basic human motivation is to strive
from a felt minus situation towards a plus situation, from a feeling of
inferiority towards superiority, perfection, totality” (Cloninger, 2013).
In the case of Suzanne, needing to be more than enough for her
parents she is wanting to get treatment for trichotillomania as well as
assessing her for depression believing that this may be a trigger for her
pulling hairs from her eyelashes and scalp.
To assess the validation of Suzanne’s diagnosis, we would need to
explore other reliable research studies to support the diagnosis. The
recovery rates resulting from a “a 3 year follow up using
metacognitive therapy” (Solem et al., 2019). “Validity results were
variable but generally strongest for clinical significance as measured
via self-report” (Nelson et al., 2014). Regard to age, socioeconomic
status, race, ethnicity , sexual orientation, gender, and religion it is one
study shows that “Among adults with TTM in this study, 10.3% had
co-occurring MDD, 18.3% had only an anxiety disorder, 10.3% had
both MDD and an anxiety disorder, and 59.8% had neither an anxiety
disorder nor MDD. Those with MDD only were more likely to be
older and be partnered (Table 1), otherwise, the groups did not
significantly differ on demographic variables” (Grant et al., 2017, pg.
3). Having validation for a diagnosis is important, without that
validation professionals will be unable to provide sufficient treatment
for Suzanne.
The risk factors of trichotillomania include family history, age, etc.,
one article states that “Genetics may contribute to the development of
trichotillomania; the disorder may occur in those who have a close
relative with the disorder” (Swemlinger.Weebly, n.d., para. 1).
Trichotillomania can develop before or during the early teen stages, in
the case of Suzanne, the symptoms of trichotillomania developed
when she was in the seventh grade. Also, for those with
trichotillomania, “hair pulling is a way of dealing with negative or
uncomfortable feelings, such as stress, anxiety, tension, loneliness,
fatigue or frustration” (Swemlinger.Weebly, n.d.,para.1). Suzanne
often felt like she was alone because she described how her parents
did not understand her, she also expressed her feeling of anxiety and
tension. Suzanne in the initial call stated that “I guess I’ve always
hated school and I’ve always been really nervous about things"
(Gorenstein &Comer, 2015, pg. 301). Basically, a lot of things such as
school, and the relationship she had with her parents had caused her a
great deal of anxiety and tension. Not to mention, individuals that
suffer from trichotillomania finding that pulling out hair provides a
satisfying feeling and relief feeling as well. As a result of those
feelings they continue to pull their hair to maintain those feelings.
However, in the case of Suzanne she is determined to figure out if
anytime she encounters a challenge if she is prone to automatically
pull out any hairs from her body.
Now, Suzanne is in a good space, the relationship with her parents is
good, she has even began dating again; however, Suzanne is
concerned of possibly being tempted into pulling her hair from her
eyelashes/ scalp again. She wants to know some preventative
measures of this not occurring again.
As of today, there is no effective treatment for trichotillomania, what
works for some patients may not work for others. For example,
treatments that are commonly used are: anti-depressants, anti-
psychotics, topiramate and lithium. Cognitive behavioral therapy is
another good form of treatment, the purpose of cognitive behavioral
therapy [CBT], is to be able to bring awareness of the client’s when
they have certain urges. CBT also helps clients with self-monitoring,
response training and stimulus control techniques. There are also other
forms of treatment including support groups, meditation, and even
hypnosis. Many individuals with hair pulling disorders are describing
their urges similar to that of an itch. Trichotillomania is disorder that
is under-studied. There is limited research in regard to this disorder,
creating a space of the understanding of trichotillomania.
In conclusion, Suzanne and her mother had made an initial call to the
helpline of obsessive compulsive and anxiety disorder; not knowing
how it began the symptoms appeared when she was in junior high
school, this continued on she went from pulling hair from her
eyelashes to pulling hair from her scalp certain events in her life is
what mainly triggered her urges.
Trichotillomania is defined as “a mental disorder that involves
recurrent, irresistible urges to pull out hair from your scalp, eyebrows
or other areas of your body, despite trying to stop” (MayoClinic, n.d.,
para.1). Along with trichotillomania Suzanne was also diagnosed with
moderate depressive disorder with anxious distress as she displayed
three symptoms out of the nine following this disorder. Suzanne wants
to determine whether when she is encountering challenges if she is
prone to pulling her hair.
