Trichotillomania is characterized by recurrent episodes of hair pulling behavior leading to noticeable loss of hair, increasing tension before hair-pulling or while coping with the urge to pull out hair, taking pleasure or a sense of relief while pulling out hair, and social, occupational, and functional impairment1.
Trichotillomania can involve any area in the body; however, the most common areas are the scalp, followed by the eyebrows and eyelashes in children and in adults2. The seriousness of the pulling behavior is perceived over time, and the disease exhibits a chronic course and it is resistant to therapy3. It has been reported that patients with trichotillomania often ...view middle of the document...
The patient then started pulling out eyebrows due to the stress caused by nausea. She felt relief from the pulling behavior. The patient reported that she engaged pulling behavior only to avoid the sense of nausea. She pulled out her eyebrows almost every day intermittently throughout the day. The pulling behavior became problematic due to the fact that it took particular time throughout the day. The family history was not remarkable for psychiatric disorders.
At the first visit, the patient looked older than her real age. Her style of dress was consistent with her socioeconomic status. The self-care was moderate, and eye contact with the interviewer was partially diminished. The patient was conscious and fully oriented. The spontaneous and voluntary attention, concentration, memory, and perception were within normal limits. The patient had normal judgment and insight. The tone of voice was normal, and speech was diminished. The flow of thought was slow. The patient was in a depressed mood and she had dysphoric affect. Physical and neurological examinations were normal. Administered to the patient in the WAIS-R Intelligence Test detected normal intelligence level.
After initial assessment, the patient was diagnosed with trichotillomania according to the diagnostic criteria of DSM-V. We started the treatment with behavioral therapy.
The hair-pulling behavior that began during pregnancy was discussed in the current case report. Trichotillomania usually begins in adolescence (age:11-15)6; however, the onset occurred at a later age in the currently reported case. Some researchers suggested that trichotillomania should be evaluated within the spectrum of obsessive compulsive disorders7. The current case supports this notion due to the difficulty of controlling the urge for hair-pulling and relief from stress with the pulling behavior. Trichotillomania classified to obsessive-compulsive and related disorders in DSM-V8.
Many studies have suggested menstruation and pregnancy to be associated with the onset and exacerbation of psychiatric symptoms9. Although studies on hair-pulling behavior during pregnancy demonstrated that pregnancy might cause an increase in the...