Trichotillomania ranging from “ritual to illness” and as a rare clinical manifestation of frontotemporal dementia: Review of literature and case report

Abstract

Frontotemporal dementia (FTD) is the most common form of dementia in the younger age group and often exists with comorbid obsessions and compulsions in up to 80% of the patients. Trichotillomania or compulsive “hair-pulling” disorder is a rare manifestation of FTD and is a poorly evaluated symptom in this condition. The release of “grooming functions” due to frontal disinhibition is often attributed to the evolutionary perspective; however, recent findings also implicate the role of neurotransmitter dysfunction. Trichotillomania is currently classified under obsessive and compulsive behavioral spectrum disorders and is often encountered in the younger population with research evidence of response to selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and newer drugs such as N-acetyl cysteine. The role of behavioral therapy also has robust evidence in trichotillomania. We herewith report the case of a middle-aged male patient who presented with features of personality change and behavioral problems in terms of anger, agitation, and disinhibitory behavior who on detailed clinical evaluation and radiological assessment had features consistent with behavioral variant of FTD along with compulsive “hair plucking” behavior which responded minimally with SSRIs. FTD can have features of trichotillomania which is an often overlooked and relatively uncommon manifestation of dementias. Treatment options such as N-acetyl cysteine and behavioral therapy could have potential utility in this degenerative condition hitherto at an earlier stage.

Repetitive Behaviors in Frontotemporal Dementia: Compulsions or Impulsions?

“…Other OCD-related behaviors can occur in bvFTD, including trichotillomania or hair-pulling and excoriation or skin-picking. 7,14 However, with the possible exception of hoarding behavior, our results demonstrate that the common repetitive behaviors of bvFTD are different from those observed in OCD.…”

Clinical presentation, diagnosis and management of aerodigestive tract foreign bodies in the adult population: Part 1

“… 34 Trichotillomania may also be seen in some neurodevelopmental disorders such as Lesch–Nyhan syndrome, which can be associated with other body-focused repetitive behaviours such as skin picking, scratching, nail, hand or finger biting, head banging, self-hitting, et cetera. 35 A Rapunzel syndrome is a rare form of gastric trichobezoar with a long tail extending beyond the stomach along the duodenum into the small intestine. 30 , 32 , 34 , 36 Small bowel obstruction is the most common clinical complication of a bezoar ( Figure 10a, b ); however, it is responsible for only 0.4% – 4% of all intestinal obstructions.…”

Dementia, delirium & neuropsychiatric conditions in Charaka indriya sthana

“…Major stereotypies (kaashtena bhumim vilikhan) shown by children with pervasive developmental disorders (PDD) are repetitive, compulsive, stereotypical, and rhythmic behaviors such as self-biting, face/head banging or hitting, handshaking, body rocking, mouthing of objects, picking at skin or body orifices, hair pulling (nakhaichhindaan shiroruhaan), breath holding, and swallowing (aerophagia). 115 The literature indicates that simple motor stereotypy such as skin-picking, head rocking, and lip pursing and complex motor stereotypy like hair-pulling, skin-picking, hand flapping, and wriggling with leg movement (kaashtena bhumim vilikhan) involve frontostriatal disease or dysfunction. 116 The above verse denotes stereotypic movement disorder or TTM or BFRBs due to various underlying neurological syndromes.…”

“…The main neuropsychiatric manifestations of FTD include disinhibition, apathy, obsessive-compulsive behavior, and Kluver-Bucy syndrome (KBS). 115 Hyperoralitly (nara swasthavat aahaaram), increased preference for sweet foods (nara swasthavat aahaaram) and poor insight (pramuhya) are found in FTD patients. 117 Despite having hyperorality and food faddisms (nara swasthavat aahaaram) etc, FTD patients show features like apathy (abala).…”