Specialist urges OCD alertness among doctors and dentists - Ulla Kristiina Laakso on obsessive-compulsive disorder

Nutrition Health Review, Wntr, 1991

What appears to be dermatitis can be the result of excessive washing with abrasive agents by patients who suffer from obsessive-compulsive disorder, says Ulla Kristiina Laakso, a New York City psychiatrist.

"It is characteristic of patients who have a 'washing problem' to use the most potent of cleansing agents," Dr. Laakso notes. "They will pour abrasive cleansers over their body, soak their hands with disinfectants, lather with harsh soap as copiously as most people will use the mildest of castile soaps. The results can be misdiagnosed, and a dermatologist who isn't aware of the syndrome will become involved in futile treatment."

Dr. Laakso has also observed that many dentists may mistake inflamed gums for gingivitis among patients who are secretive about their obssessive-compulsive disorder and indulge in excessive brushing of teeth. She has treated patients who admit to brushing teeth for several hours daily.

When pediatricians and dermatologists are confronted with cases of hair loss that cannot be explained medically, Dr. Laakso says, the answer may be found in trichotillomania, compulsive hair pulling. (It is estimated that as many as several million people in the U.S.A. are affected.)

"Trichotillomania usually begins in childhood," Dr. Laakso explains, "and occurs mostly in adolescent girls and women. Perhaps males suffer from the problem too, but we may be missing them because baldness in young men and adult males is not unusual.

"Although treatments for trichotillmania have been attempted by psychotherapists and psychoanalysts, the medical literature does not supply clear evidence of success," she observes. "We are more hopeful about clomipramine, which seems to be helpful. The drug has only recently been cleared by the Food and Drug Administration, so significant statistics have yet to be established."

Dr. Laakso agrees with Dr. Judith Rapoport, a leading authority on the subject of OCD, that a close relationship exists between trichotillomania and obsessive-compulsive disorder and that clomipramine could be effective.