Trichotillomania Disorder Assessment, Treatment, and Complications

Trichotillomania Disorder Assessment, Treatment, and Complications
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Carol is a 20-year-old engaged Caucasian female working part-time as a clerk for a local logistics company. Her father referred her to an outpatient psychological services center after her hair-pulling behavior worsened and there were visible patches on her scalp. At the initial intake, Carol was in her second year in college and lived in an apartment with her workmate, with whom she got along relatively well. At information, Carol explained that her symptoms of hair pulling started when she was ten years old but became more severe after being diagnosed with severe depression. However, it was not until very recently that her father noticed her symptoms and encouraged her to see a therapist, even going ahead to make an appointment for her. Even though Carol was hesitant about seeing a clinician, she was very forthcoming in her responses. She maintained good rapport, as shown by the candid and friendly manner she answered questions.
Allison reported that her hair-pulling behavior started as an experiment and was focused on upper eyelashes. She remembered seeing her classmates making wishes with their loose eyelashes and eyebrows. Carol would also begin to pulling out her eyelashes and eyebrows to make wishes. She would pull short and stubby hairs, especially when her eyelashes or eyebrows were clumped together or sticking out. This pulling of hairs that were “out of line” would become a habit and continue with lowered awareness when watching a movie or seated at her desk studying. Carol confessed to experiencing calmness, pleasure, and satisfaction in these hair-pulling episodes. However, the passing away of her mother in a car accident was very harrowing for her, and she was diagnosed with severe depression. Carol reported that her hair-pulling behavior became more frequent after the traumatic event, and she started pulling out hair from her scalp.
This habit was more pronounced when she was stressed by life events, especially social situations, and academics. Carol reported suffering anxiety directly related to her hair-pulling behavior, namely, worrying that her father would notice her lack of eyebrow/eyelash hair and the shrinking scalp. She not only feared her father's reprimand but the embarrassment of her peers seeing the lack of eyebrow/eyelash hair along with the shrinking scalp and asking questions. Consequently, Carol wore false eyelashes and applied heavy makeup to ensure that others, especially her father, did not notice. Besides, she always wore a baseball cap to hide the patches of missing hair on her scalp. She refrained from all activities that would require removing the makeup, false eyelashes, and baseball cap, such as swimming. Carol also confessed to having a good relationship with her father and two younger siblings, with whom she assumed a parental figure after her mother's death.
Even though she tried several times to stop her hair pulling tendencies, she admitted that the daily stressors of academics, work, and social life impeded her ability to control the behavior. Car...