Trichotillomania in Childhood: Case Series and Review

Abstract

ABSTRACT. Trichotillomania is a relatively common cause of childhood alopecia. We report our observations of 10 children with trichotillomania seen over a 2-year period at Texas Children's Hospital. Patient ages ranged from 9 to 14 years (mean: 11.3 years) with an equal gender ratio. The duration of hair-pulling ranged from 1 month to 10 years (median: 4.6 months). The scalp alone was affected in 8 cases, the scalp and eyelashes in 1 case, and the eyelashes alone in 1 case. The frontal scalp and vertex were the most common sites affected. Associated findings included nail-biting in 2 cases, "picking" of the skin in 1 case, and headaches in another case. Noted precipitating factors in 3 patients included "stress" at home and school. Associated psychopathology included major depression in 1 case, attention-deficit/hyperactivity disorder in 1 case, and an "anxious and nervous personality" in 1 case. The most important differential diagnosis to exclude from trichotillomania is alopecia areata, which was seen concomitantly in 1 patient and preceded the onset of hair-pulling by 11 months. Eight patients were referred to a child psychologist for additional management, of which 2 were subsequently treated with antidepressant medication. Trichotillomania is a disorder of multifaceted pathology, and an interdisciplinary approach to management is often helpful. The common prepubertal age of onset provides an important opportunity for the pediatrician to lend support to affected patients and their families. Pediatrics 2004;113:e494 -e498. URL: http://www.pediatrics.org/cgi/content/full/113/ 5/e494; trichotillomania, hair-pulling.

Childhood onset trichotillomania: a retrospective analysis of 78 cases visiting tertiary general hospital

“…2 Arising primarily in children and adolescents, TTM is a relatively common cause of childhood alopecia. 3 The 4 th edition of the diagnostic and statistical manual of mental disorders (DSM-IV) included TTM under other disorders of "impulse control" such as pyromania, kleptomania, and pathologic gambling. 4 These conditions share in common a sense of tension before performing a given act and gratification and/or relief after completion.…”

“…However, many patients with TTM, especially children, deny this tension/gratification phenomenon and therefore do not meet DSM-IV criteria for the disorder. 3 Thus it was suggested that TTM be included under anxiety disorders, because it shares some obsessive-compulsive features. In accordance with these findings the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included TTM under obsessive compulsive and related disorders.…”

Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

“…Using an ABAC design (Barlow, Nock, & Hersen, 2008), in which each treatment was introduced between baseline reversals, the behavior was reduced to near-zero levels and maintained at 2-month follow-up. It should be noted that the two of the previously mentioned studies used 3-year-old children with TTM as participants (Altman et al, 1982;Massong et al, 1980), and some have suggested that very young children with hair pulling might represent a distinct group from those who begin hair pulling later in childhood, such that they have a more time-limited course and favorable prognosis (Lewin et al, 2009;Santhanam, Fairley, & Rogers, 2008;Swedo et al, 1992;Tay, Levy, & Metry, 2004). This caveat may limit the generalizability of results from those two studies.…”

Kardeşlerinin saçını yolan farklı bir trikotillomani olgusu / The child who pulls his little brothers’ hair: a different trichotillomania case

“…T richotillomania (TTM) is a relatively common cause of childhood alopecia (1). TTM is an atypical impulse control disorder according to DSM-IV-TR, in which patients undertake repetitive, damaging hair-pulling that leads to debilitating and noticeable hair loss (2).…”