Complicated case of trichotillomania: management and follow-up

Trichotillomania (hair-pulling disorder) is characterized by the persistent and excessive pulling of one’s own hair, resulting in noticeable hair loss. It is classified as obsessive-compulsive and related disorders in DSM-5 and there has been a set of changes in diagnostic criteria for trichotillomania. The word ‘noticeable’ is deleted from criterion A and concluded that there were insufficient data to justify the inclusion of diagnostic criteria describing the rising tension before hair-pulling or pleasure, relief, and gratification after a hair-pulling. In one study, excluding the criteria building tension and relief while pulling and not meeting the full criteria necessary for a trichotillomania, hair-pulling behaviors have been reported 3.4 %in females and 1.5% in males. In another study, relatively small percentage (1.4%) of the sample reported having been hospitalized for hair pulling. In this case report, a 29-year-old female trichotillomania patient is presented. She was pulling hair from the scalp and various body parts such as pubic area and skin picking almost from the entire skin. She has started with pulling from her eyebrow twelve years ago and she is pulling hair from scalp for the last four years. She had depressed mood, loss of appetite, insomnia, and fatigue for the last month. In addition, she could not take care of her children and house, and she had hair-loss near baldness. She had attempted suicide a week before her admission and she was hospitalized for suicide risk. She was treated with risperidone and şuvoxamine as an inpatient. Her psychotherapy was planned as cognitive restructuring and habit reversal training. After her hospitalization she has been followed-up for six months.