拔毛症診斷準則及其治療

Diagnostic Criteria and Treatment of Trichotillomania

吳貞瑩(Chen-Ying Wu) ； 羅筠(Yun Lo) ； 翁菁菁(Jing-Jing Wong) ； 鄒國蘇(Guo-Su Zou) ； 何淑賢(Suk-Yin Ho)

《北市醫學雜誌》 12卷3期 (2015/09) Pp. 9-16

https://doi.org/10.6200/TCMJ.2015.12.3.02

摘要

拔毛症主要表現是無法克制的拔毛所造成的困擾，過去一直被歸類在衝動控制疾患。2013年DSM-5（Diagnostic and Statistical Manual of Mental Disorders 5^(th) edition）將其改放在強迫症及其相關疾患，診斷準則也有不少修改，顯示其病理概念的改變。拔毛症一直沒有有效的治療方法。藥物治療的統計研究中，沒有藥物可以得到顯著且一致的結果。最常用的藥物為選擇性血清素抑制劑，其中以fluoxetine最常用。抗精神病藥中的olanzapine也有一些報告顯示有效。Aripiprozole和naltrexone也有零星報告顯示有效。N-acetylcysteine則是最近被研究的藥物。行為治療在研究中顯示比藥物治療更有效，習慣反轉訓練、及自我接受和承諾改變療法在研究都有不錯的效果。拔毛症治療研究目前沒有一致的結果，疾病歸類仍持續被討論，需持續研究並了解其症狀及病理有助於找到更好更有效的治療方法。

關鍵字

拔毛症 ； 精神疾病診斷準則第五版 ； 強迫症 ； 專注身體的重複行為障礙症

並列摘要

Trichotillomania is characterized by irresistible repeating hair-pulling behavior and causing significant distress. It is classified as an impulse-control disorder (not classified elsewhere) in the previous editions of Diagnostic and Statistical Manual of Mental Disorders (DSM). However, the 5th edition (DSM-5) published in 2013 places trichotillomania in the category of obsessive-compulsive and related disorders. Some details about the emotion response and hair quantity are excluded from the new diagnostic criteria. There is still no effective treatment for trichotillomania. Therapeutic effect studies of pharmaceutics treatment revealed inconsistent results. The most common pharmaceutics used to treat trichotillomania are selective serotonin reuptake inhibitors, especially fluoxetine; the medications did not show better effect than placebo in some of the studies. Treatment with olanzapine, an antipsychotic drug, showed positive effect in some of the studies. Aripiprozole and naltrexone have few reports to support their effect. N-acetylcysteine is a new medication which needs more evidence to prove its effectiveness. Behavioral therapy is another common choice and has been proven more effective as compared with pharmaceutics. Both habit reversal training and acceptance and commitment therapy have demonstrated promises in treating trichotillomania. Current managements for trichotillomania is unsatisfying. Further researches on psychopathology and symptomology of the disorder are needed for developing efficacious treatments.

並列關鍵字

Trichotillomaina ； Hair-pulling disorder ； DSM-5 ； Obsessive-compulsive disorder ； Body-focused repetitive behavior disorder