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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EWithin the spectrum of obsessive-compulsive disorders (OCD), distinctive behaviors exist that do not respond to typical OCD treatments, including skin picking and trichotillomania (TRIC). Awareness of these disorders is not widespread, but their prevalence is not insignificant. The number of individuals with TRIC also is higher than might be expected; a study of several thousand college students reported an incidence of 5% overall.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Echild \u0026amp; adolescent anxiety disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Esomatoform disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EWithin the spectrum of obsessive-compulsive disorders (OCD), distinctive behaviors exist that do not respond to typical OCD treatments, including skin picking and trichotillomania (TRIC). Awareness of these disorders is not widespread, but Jon Grant, JD, MD, University of Minnesota, Minneapolis, MN, emphasized that their prevalence is not insignificant. He reported that 11.8% of adolescent inpatients he surveyed were identified as actively skin picking. \u201cImportantly, this is not a behavior to be confused with body dysmorphic disorder: This is not picking to improve appearance. This is more like nail biting \u2013 most patients are not even aware that they\u0027re doing it.\u201d The number of individuals with TRIC also is higher than might be expected; a study of several thousand college students reported an incidence of 5% overall.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EOnset for both disorders is early\u201410 to 15 years of age\u2014and unlike the behaviors that are typical of OCD, these tend to involve pleasure or gratification. \u201cHistorically, people always thought of these as OCD problems, but they don\u0027t respond at all\u2014or not as robustly\u2014to the same treatments.\u201d To identify the TRIC patient, look for recurrent pulling of hair that results in noticeable hair loss, a sense of tension before pulling, pleasure or relief at the time of pulling, and often, with men, eating of the hair. TRIC also is often seen with comorbid nail biting.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EDiagnostic criteria for skin picking include recurrent picking at or manipulating of the skin (anywhere on the body) that results in noticeable damage, picking of the skin using any tool (nails, tweezers, etc), many hours of picking, and additional picking at night. To emphasize the seriousness of this condition, consider that 45% of such patients have scarring, 30% experiences infections, and 3% actually requires grafts to restore skin integrity.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003E\u201cFrom a treatment perspective, what has befuddled clinicians about these diagnoses is \u2018How do we characterize them?\u2019\u201d said Dr. Grant. \u201cAre these really just variants of OCD?\u201d Clinical studies say no. SSRIs that are effective in OCD have few responders among TRIC patients. On the other hand, TRIC may respond to naltrexone and other anti-addictive medications, while OCD does not. This last observation is suggestive of certain correlations; comorbid substance abuse is higher for TRIC than OCD, and rates are higher still for skin picking relative to TRIC. \u201cPerhaps an addiction model might be useful to look at for these behaviors.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDr. Grant reported an ongoing study using N-acetyl cysteine to treat TRIC. \u201cWe actually use this amino acid in gambling addiction.\u201d In his current blinded investigation, 50 patients were enrolled and randomized to 2400 mg of active agent or placebo. Though interim results are still blinded, some patients have reported having stopped picking for the first time in their lives, an outcome that is so profound that Dr. Grant doubts that it could be merely a placebo effect.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EDr. Grant also reported recent data for lamotrigine (median dose, 200 mg\/day), which demonstrated a reduction in skin picking from an average of 2 hours a day to just one hour a day (n=24). Though there are no on-label therapies for either disorder, other treatment options that might be considered are naltrexone, acamprosate, baclofen, isradipine, or ondansetron. Dr. Grant stresses, however, that these interventions may have little or no effect for the patient who does not report pleasure or urges that are related to the dysfunctional activity. \u201cYou need to really take a close look at the family history and all of the comorbidities to get at what\u0027s really driving the behavior.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EFor more information on trichotillomania, please visit \u003Ca href=\u0022http:\/\/www.trich.org\u0022\u003Ewww.trich.org\u003C\/a\u003E.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/3\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzme61\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}