7.4 Body Dysmorphic Disorder and Hair-Pulling Disorder

Question 1

Body Dysmorphic Disorder

Answer 1

• Belief that body is deformed or defective in some specific way
• Most commonly imagined slight flaws in face or head such as wrinkles or scars, shape of nose, excessive facial hair, and facial asymmetry.
• This is not a delusion because the patient is aware that their beliefs are exaggerated.
• Can lead to psychotic disorders.

Comorbid Conditions
- Major depressive disorder (common)
- Anxiety
- Psychotic disorder
- OCD (common)

Manifestations
- Repetitive mirror checking, excessive grooming, skin picking, seeking assurance.

Question 2

Hair Pulling Disorder (Trichotillomania)

Answer 2

• Recurrent pulling out of hair that results in loss.
• Impulse is caused by a feeling of tension that is relieved (gratified) from pulling out hair.
• Can occur anywhere but most commonly pulled from scalp, eyebrows and eyelashes.

Comorbid Conditions
- Mood disorders
- Eating disorders
- Anxiety disorders
- Substance Abuse
- Personality Disorders

Question 3

Learning Theory

Answer 3

OCD is caused by a response to a traumatic event which produces anxiety/discomfort. Individual learns to prevent their anxiety with OCD.

Passive avoidance - Prevent anxiety by avoiding the situation

Active avoidance - Behaviors that provide relief from the anxiety associated with traumatic event.

Question 4

Psychosocial Influences related to Trichotillomania

Answer 4

• Related to stressful events
• Disturbances in mother-child relationships
• Fear of abandonment
• Recent Object Loss

Question 5

Biological Aspects

Answer 5

• Hairpulling may be genetic
• Serotonin may influence OCD

Medications
- Clomipramine and SSRIs block re-uptake of serotonin which may prevent OCD