Cohen L J, Stein D J, Simeon D, Spadaccini E, Rosen J, Aronowitz B, Hollander E
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Clin Psychiatry. 1995 Jul;56(7):319-26.
Trichotillomania, characterized by an irresistible urge to pull one's hair, may be more prevalent than previously believed. Despite increasing attention devoted to this topic in the recent literature, there are few studies based on large samples that are potentially generalizable to a community population.
Surveys addressing clinical profile, comorbidity, and treatment history were mailed to all responders to a nationally distributed magazine article on trichotillomania. Out of 772 surveys sent, 123 completed surveys were returned.
While there was a predominance of females in the whole sample, female-to-male prevalence was lower in children than adults. Onset was predominantly in childhood (mean age = 11 years), most frequently in middle childhood and least frequently before age 6. Subjects pulled hair from a variety of sites, including scalp, eyelashes, eyebrows, pubic region, face, and body, but the highest incidence and severity involved scalp hair. Children under 6 were more likely than other age groups to pull scalp hair and possibly less likely to pull other hair. In adults, symptom profile was not associated with age at onset. While subjects reported high rates of comorbid conditions in both self and family, trichotillomania was reportedly formally diagnosed in only 40% of the subjects. Although subjects reported a range of treatments, the majority (58%) reported no treatment history. Finally, only minimal improvement was reported for all modalities, with no significant difference in response to psychotherapy, behavior therapy, clomipramine, or fluoxetine.
Trichotillomania is a chronic illness that may be difficult to treat. Controlled studies on comorbidity, epidemiology, treatment-seeking patterns, and long-term treatment response are needed.
拔毛癖的特征是难以抑制的拔毛发冲动，其患病率可能比之前认为的更高。尽管近期文献对该主题的关注日益增加，但基于大样本且有可能推广至社区人群的研究却很少。
针对一篇在全国发行的杂志上关于拔毛癖的文章，向所有回复者邮寄了有关临床特征、共病情况及治疗史的调查问卷。在寄出的772份调查问卷中，共收到123份完整回复。
整个样本中女性占多数，但儿童中女性与男性的患病率差异低于成年人。发病主要集中在儿童期（平均年龄 = 11岁），最常见于童年中期，6岁前发病最少。患者从多个部位拔毛，包括头皮、睫毛、眉毛、耻骨区、面部和身体，但发生率和严重程度最高的是拔头皮毛发。6岁以下儿童比其他年龄组更易拔头皮毛发，而拔其他部位毛发的可能性可能较小。在成年人中，症状特征与发病年龄无关。虽然患者报告自身及家族中共病情况发生率较高，但据报告仅40%的患者被正式诊断为拔毛癖。尽管患者报告了一系列治疗方法，但大多数（58%）表示没有治疗史。最后，所有治疗方式的改善都很有限，心理治疗、行为治疗、氯米帕明或氟西汀的疗效无显著差异。
拔毛癖是一种可能难以治疗慢性病。需要对共病情况、流行病学、求治模式及长期治疗反应进行对照研究。
