Is Trich OCD, ICD, or something else?
This extract comes from something that my friend Mike Grant wrote on the TTM mailer.
As always, no claims are made, this is his personal opinion - but I think it gives
some insight into the differences. I think I can safely say that the general feeling
is that trich doesn't fall directly in OCD or ICD. Who knows what exactly it is?
At this stage there are still so many unanswerered questions and we just have to
make the most of what we know at this stage. -- Amanda
It has long been speculated that the mechanism
responsible for the onset of ttm may not be the same in many cases as what
sustains it. Of course, as in just about everything with this disorder, it's
speculation.
Trichotillomania when seen by itself is a regarded as an impulsive control
disorder. In ways, it mimics an obsessive-compulsive disorder, but only
superficially. The difference lies in the driving force behind the pulling.
A compulsion is a repeative unwanted behavior brought on by some obsessive
ideation. An obsession is a recurring unwanted thought. The classic case of
OCD was the boy who could not stop washing his hands. The handwashing was
carried based on the boy's obsession with cleanliness. The compulsive
behavior is seen as a coping mechanism for dealing with the obsession.
There are some case of ttm that resemble OCD more than others. Sometimes an
individual may pull based on the idea they are removing "bad" hairs. There is
obsessive thinking underlying the action. One of the things John and I have
been exploring is that in some individuals maybe there *is* something
demonstrably pecular about the hairs that are pulled and this anamolies may
cause itching and/or discomfort which is relieved by pulling the offending
hair. In which case, the individual has a dermatological disorder and neither
OCD nor ttm.
What makes ttm an impulse control disorder rather than OCD is the pulling
behavior is driven by an impulse. Compulsive behavior reduces the anxiety
brought on by obsessive thoughts, which is what sustains the behavior. An
impulse on the other hand is a behavior that produces pleasure or comfort.
Like candy, it is something that produces pleasure so the motivation behind
eating it is self-evident. However, although the behavior may give pleasure
to the individual, the individual may realize there are consequences to the
behavior, such as obesity in the case of the candy or baldness in the case of
hairpulling. Because of societal expections, few people would chose to be
obese or bad. So the individual is faced with a dilemma. One part of the
individual feels the urge to eat the candy while at the same time the
individual's reasoning is telling them not to because of the consequences. It
a case of short term gratification versus long term consequences, or more
exactly, impulse versus reason. Everyone is faced with this choices in their
daily lives. Most people learn to control their impulses sufficiently so as
to avoid the consequences which might have an adverse impact on their lives.
This learning behavior begins at infancy. Infants start out driven purely by
impulse. That's why the need an adult to care for them to, amoung other
things, keep their impulses from getting them into trouble. As the infant
matures, he or she gains competency over their biological impulses. Later on,
the growing child gains competency over managing their emotional impulses as
well. This is a learning which continues throughout life. The emphasis being
impulse control is a learning process. Some impulses we learn to deal with
better than others. I give into the impulse to eat, especially things I
shouldn't, far too often. That's why I'm overweight. Others can't deal with
the emotion of anger and give in to acting out hostile impulses. Still others
may give into impulsive buying only to regret the credit card bills at the end
of the month. So what lies behind the hairpulling in trichotillomania is well
within the common human experience. The unique aspect of ttm isn't the
hairpulling itself, but rather the sensory alteration in which pulling
provides pleasure. I strongly believe this component in many cases is
physiological and not psychological in nature and is the only thing that
distinguishes the ttm sufferer from everyone else.