Trichotillomania and OCD – What They Have in Common, and How They Differ

Similarities between OCD and Trichotillomania

Researchers have discussed similarities and differences between trichotillomania and OCD. One of the clearest similarities has to do with the compulsions that appear to drive both disorders. In OCD, these compulsions push the sufferer to engage in repetitive, anxiety-relieving behaviors that must be done or more anxiety will result. In trichotillomania, the compulsions arise from anxiety or trauma and result in hair pulling to get relief or comfort.

Another possible similarity is in comorbidity statistics. This suggests if one of the conditions exists, the other likely does, also.

Another similarity has to do with being able to stop the behavior. In trichotillomania, the person suffering from it is unable to voluntarily stop pulling their hair. In OCD, the fear of developing more anxiety if the behavior isn’t engaged in perpetuates it.

Another indication that OCD and trichotillomania are similar is that the two conditions appear to be affected by and affect the parts of the brain that control habits and repetitive actions. It has been suggested that the two conditions may simply be different ways of showing the same behaviors since the same parts of the brain are affected by both disorders.

Yet another similarity between the two disorders is a suggested genetic link between them. Support for this belief is that a large number of relatives of those who have trichotillomania also report having obsessive-compulsive disorder symptoms.


Differences between OCD and Trichotillomania

Differences have also been seen between these two disorders. Perhaps the most obvious difference is that in OCD, the behaviors performed in response to the compulsion are done because of anxiety generated from obsessive thoughts. Compulsive hair pulling is not due to these kinds of thoughts but comes from an irresistible impulse. Also, pulling the hair in this disorder leads to comfort and a sense of relief.

Another difference between OCD and trichotillomania has to do with behaviors changing in severity and focus over time. This is common in OCD but does not happen with trichotillomania. The hair pulling that occurs with trichotillomania does not typically increase nor does it shift to another behavior.

The prevalence of the two disorders also is a difference between them. OCD is typically found equally distributed between males and females. In trichotillomania, many more females are reported with the disorder than males. However, this may be a reflection of reporting errors rather than a genuine finding. Due to the shame and stigma attached to trichotillomania and the reluctance of men to report having the symptoms or to seek treatment, the numbers may be more similar than reported.

Another difference may be seen in age of onset. While both disorders tend to show themselves first in childhood and early adolescence, in OCD males report earlier onset than females. In trichotillomania, the opposite is reported; females report symptoms earlier than males.

Trichotillomania sufferers report fewer OCD symptoms comorbidly and have fewer instances of depression. Related to this, an attempt to prevent the compulsive behaviors in OCD leads to lower anxiety, but the same attempt with those suffering from trichotillomania, anxiety is increased.

Medication intervention with SSRIs tends to be beneficial to an extent with both disorders. However, in OCD the response is sustained longer. In trichotillomania, the response is more variable.

People with trichotillomania report a feeling of pleasure from the pulling of their hair. This feeling is not present with the behaviors engaged in by those with OCD.

Some healthcare professionals believe trichotillomania belongs in the category of body-focused repetitive behaviors along with skin-picking and some other behaviors. This is a completely different category than OCD.

Another significant difference between OCD and trichotillomania is that people with OCD report more lifelong disability compared to trichotillomania.

While both OCD and trichotillomania typically worsen during menstruation, OCD often significantly worsens during pregnancy.

Another important difference between OCD and trichotillomania has to do with when the repetitive behaviors occur. These behaviors shown with OCD tend to occur more frequently when anxiety increases. With trichotillomania, there may be hair pulling in response to anxiety, but the behavior seems more related to boredom or other times when the behavior seems to be automatic. This makes hair pulling more a habit disorder than a compulsive disorder. This difference seems to be more likely when considering the treatment of habit reversal, one of the most effective treatment approaches for trichotillomania, was originally developed to deal with unwanted habits.

While some researchers believe the same parts of the brain are affected by both OCD and trichotillomania, more recent research calls this into question. It is not yet determined absolutely whether the same parts of the brain are affected by both conditions.

Regardless of the similarities or differences of these conditions, both lead to significant limitations in the life of those suffering from them. There is help available for both conditions, as well. Awareness of the conditions will lead to support for those with them and possibly to more people seeking help.

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