Repetitive Behaviour Disorders

Question 1

What is trichotillomania?

Answer 1

• Recurrent pulling out of one’s hair, resulting in hair loss
• Repeated attempts to decrease or stop hair pulling
• The hair pulling causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The hair pulling or hair loss is not attributable to another medical condition
• The hair pulling is not better explained by the symptoms of another mental disorder

Question 2

What is the extent of trichotillomania?

Answer 2

• The hair pulling usually takes place in private and the hair-puller will make attempts to cover it up
• The hair-puller may be only partly aware of his/her behaviour, and pull hair while watching TV or talking on the phone
• The person may pull hair from animals and dolls
• Related obsessive disorders of a body-focused nature are common, such as nail biting or picking skin

Question 3

What is the cause of trichotillomania?

Answer 3

• Precise etiology of TTM is unknown
• May be maintained by negative reinforcement via the immediate but temporary reduction in the intensity of unpleasant private events contingent on hair-pulling

Question 4

What is the drug treatment for trichotillomania?

Answer 4

• Selective serotonin reuptake inhibitors (SSRI) anti-depressants
• Fluoxetine no better than a placebo
• Clomimpramine’s effects are reversed after 3 months

Question 5

What are tic disorders

Answer 5

• E.g. head-jerking, facial grimacing, vocal tics
• May involve heightened muscle tension, sometimes the development of a tic is related to an injury
• Vocal tic: rapid, recurrent, non-rhythmic stereotyped vocalisations, such as grunting, sniffing, coughing or throat clearing not associated with illness
• Categorised as ‘transient’ when they remit within 1 year of onset

Question 6

What is tourette syndrome (TS)?

Answer 6

• Childhood onset, recurrent, sudden, stereotyped motor movements and vocalisations
• 0.04-3% of population
• More common in males

Question 7

What is habit reversal training (HRT)?

Answer 7

• Based on the rational that tic reduction is possible if an individual becomes more aware of his or her tics and performs a physically competing response to prevent or interrupt their occurrence
• Simplified HRT is easier to administer than original HRT, has been shown to be equally as effective, and can usually be taught in eight 1 hour sessions or less

Question 8

Thumb sucking

Answer 8

• Occurs in 23-46% of children aged 1-4 years
• Various behavioural interventions, such as the application of aversive-tasting substances to the thumb, differential reinforcement, time-out, token economy programs, and habit reversal, have been moderately to highly successful in treating this behaviour