Trichotillomania

Abstract

Recently, trichotillomania has been classified under the disorders of impulse control and defined in a discrete and comprehensive way [1,2]. Trichotillomania is a chronic maladaptive and self-destructive pattern of behavior with a neurotic dimension and results in considerable cosmetic impairment, social isolation, and other dangerous complications [3]. For some it is a symbolic dermatological expression of underlying psychosocial stresses which are often denied by patients [4,5]. Although the sociodemographic correlates of trichotillomania continue to beexplored, it is known to have a predilection for female subjects and is predominantly found in children, as has been substantiated by an experimental study [6] and also strongly supported by the observations of others [1,4,5]. Further, there is a general agreement that trichotillomania is a heterogeneous disorder, and therefore a variety of etiological interpretations have been proposed by various researchers [7][8][9]. There is, however, a dearth of research on the biological aspects of the disorder.It . Interestingly, according to DSM-IIIR criteria, substance abuse disorders contribute to the development of trichotillomania. The presentation of trichotillomania is characteristic, but it can be confused with many different types of alopecia, as reported by various researchers [4,15]. In relation to this, punch biopsy of affected scalp is useful in confirming the clinical diagnosis of trichotillomania [1,4]. Numerous therapeutic modalities have been derived from the theoretical concepts of trichotillomania, and these range from behavioral techniques [16][17][18][19][20][21] to psychodynamic therapies [4,12,22] to psychotropic drugs [3,13]. Though a matter of individual preference, the best approach for the treatment of trichotillomania would be a combination of pharmacological drugs, especially clomipramine, and one of the behavioral techniques.We describe a case of trichotillomania, knuckle biting, and nocturnal enuresis which occurred consecutively in the same patient.A 19-year-old unmarried male Palestinian medical student, living in Yemen, was brought by his parents to the Psychiatric Clinic of Buraidah Mental Health Hospital because for the previous two years he had been pulling out his hair. The solitary act of pulling out hair, preferably from the left temporoparietal region of the scalp using exclusively the left hand, was always preceded by emotional tension caused by constant parental pressure concerning his studies, outdoor activities, and other relatively unimportant matters. Following each episode of hair pulling, the patient would feel relief and hide the evulsed hairs under the tablecloth or bed, rather than eating them. This chronic self-inflicted behavior resulted in incomplete loss of hair and his educational standing also decreased. Other than the hair pulling, the patient did not exhibit any manifestations of psychiatric illness. Retrospective evaluation of the patient revealed that early developmental milestones were not delayed, except noct...