“Pulling hair out of the head” - the importance of traumatic family events in the development and maintenance of trichotillomania symptoms - case report

Open access


Introduction: Trichotillomania is a mental disorder characterized by a repetitive and compulsive hair pulling, classified in ICD-10 to a group of habit and impulse disorders, and in the DSM-5 to the group of obsessive-compulsive disorders.

Aim: The aim of the study is to present on the basis of case study:1). the importance of traumatic family experiences in releasing as well as maintaining the symptoms of Trichotillomania, 2). comprehensive medical care, the application of which has resulted in a beneficial therapeutic effect.

Results: In the described case of 16-year-old patient, Trichotillomania was triggered by traumatic events related to lack of support and family stabilization resulting from parental disputes and grandfather’s death, when she was 11 years old. The subsequent years of her life, in spite of the divorce of her parents and their separate residence, abounded in periods of turbulent quarrels between the parents in which she was involved. Each time this type of incident was associated with the recurrence of behavior associated with Trichotil-lomania, the course of which was more severe with the occurrence of self-harm and suicidal thoughts.

Conclusions: 1. In the described case, traumatic events and pathological relations of the immediate family members were not only thetriggering factor, but also maintaining the Trichotillomania symptoms. 2. In accordance with the guidelines of Trichotillomania Learning Center-Scientific Advisory Board (2008), the use of a comprehensive treatment including both the patient - individual psycho-therapy (especially cognitive-behavioral therapy) and pharmacotherapy, as well as her family (family psychotherapy, family mediation, workshops for parents), brought about positive therapeutic effects.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization; 1992.

  • 2. Diagnostic and statistical manual of mental disorders. Fifth edition (DSM-5). Washington DC: American Psychiatric Association; 2013.

  • 3. Christenson GA Pyle RL Mitchell JE. Estimated lifetime prevalence of trichotillomania in college-students. Journal of Clinical Psychiatry. 1991; 52: 415-417.

  • 4. Cohen LJ Stein DJ Simeon D Spadaccini E Rosen J Aronowitz B Hollander E. Clinical profile comorbidity and treatment history in 123 hair pullers – a survey study. Journal of Clinical Psychiatry. 1995; 56: 319-326

  • 5. Woods DW Flessner CA Franklin ME Keuthen NJ Goodwin RD Stein DJ Walther MR Trichotillomania Learning Ctr S. The tricho-tillomania impact project (tip): Exploring phenomenology functional impairment and treatment utilization. Journal of Clinical Psychiatry. 2006; 67: 1877-1888.

  • 6. Mehregan AH. Trichotillomania – a clinicopathologic study. Archives of Dermatology. 1970; 102: 129-133.

  • 7. Keren M Ron-Miara A Feldman R Tyano S. Some reflections on infancy-onset trichotillomania. Psychoanal. Study Child 2006; 61: 254–272

  • 8. Keuthen NJ Makris N Schlerf JE Martis B Savage CR McMullin K Seidman LJ Schmahmann JD Kennedy DN Hodge SM Rauch SL. Evidence for Reduced Cerebellar Volumes in Trichotillomania. Biol Psychiatry 2007;61:374 –381

  • 9. Novak CE Keuthen NJ Stewart SE Pauls DL. 2009. A Twin Concordance Study of Trichotillomania. Am J Med Genet Part B 150B:944–949

  • 10. Zuchner S Cuccaro ML Tran-Viet KN et al. SLITRK1 mutations in trichotillomania. Mol Psychiatry 2006;11:887-9.

  • 11. Jacobs B. L. & Fornal C. A. (1995). Activation of 5-HT neuronal activity during motor behavior. Seminars in Neuroscience 7 401−408

  • 12. Gershuny B. S. Keuthen N. J. Gentes E. L. Infield A. L. & Jenike M. A. (2006). Current posttraumatic stress disorder and history of trauma in trichotillomania. Journal of Clinical Psychology 62 1521−1529

  • 13. Lochner C. du Toit P. L. Zungu-Dirwayi N. Marais A. van Kradenburg J. Curr B. et al. (2002). Childhood trauma in obses-sive-compulsive disorder trichotillomania and controls. Depression and Anxiety 15 66−68.

  • 14. Evans B. A case of trichotillomania in a child treated in a home token program. J Behav Ther Exp Psychiatry 1976; 7: 197-8

  • 15. 15. Gray JJ. Positive reinforcement and punishment in the treatment of childhood trichotillomania. J Behav Ther Exp Psychiatry 1979; 10: 125-9

  • 16. Stabler B Warren AB. Behavioral contracting in treating trichotil-lomania: case note. Psychol Rep 1974; 34: 401-2

  • 17. Christenson GA Mackenzie TB Mitchell JE. Characteristics of 60 adult chronic hair pullers. Am. J. Psychiatry 1991; 148: 365–370.

  • 18. Stein DJ Bouwer C Maud CM. Use of the selective serotonin reuptake inhibitor citalopram in treatment of trichotillomania. European Archives of Psychiatry and Clinical Neuroscience. 1997; 247: 234-236.

  • 19. Iancu I Weizman A Kindler S Sasson Y Zohar J. Serotonergic drugs in trichotillomania: Treatment results in 12 patients. Journal of Nervous and Mental Disease. 1996; 184: 641-644.

  • 20. Ninan PT Knight B Kirk L Rothbaum BO Kelsey J Nemeroff CB. A controlled trial of venlafaxine in trichotillomania: Interim phase i results. Psychopharmacology Bulletin. 1998; 34: 221-224.

  • 21. Marsteller FA Knight BT Eccard MB. A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania. Journal of Clinical Psychiatry. 2000; 61: 47-50.

  • 22. Grant JE Odlaug BL Chamberlain SR Kim SW. Dronabinol a cannabinoid agonist reduces hair pulling in trichotillomania: A pilot study. Psychopharmacology. 2011; 218: 493-502

  • 23. Odlaug BL. Clinical characteristics of trichotillomania with trichophagia. Compr. Psychiatry 2008; 49: 579–584

  • 24. Bouwer C Stein DJ. Trichobezoars in trichotillomania: case report and literature overview. Psychosom. Med. 1998; 60: 658–660

  • 25. Adewuya EC Zinser W Thomas C. Trichotillomania: A case of response to valproic acid. Journal of Child and Adolescent Psychopharmacology. 2008; 18: 533-536.

  • 26. Berk M McKenzie H Dodd S. Trichotillomania: Response to lithium in a person with comorbid bipolar disorder. Human Psy chopharmacology-Clinical and Experimental. 2003; 18: 576-577.

  • 27. Christenson G. A. Crow S. J. MacKenzie T.B. et al. (May 1994). A placebo controlled double-blind study of naltrexone for tricho-tillomania [Abstract]. New Research Program and Abstracts of the 150th Annual Meeting of the American Psychiatric Association.

  • 28. Van Ameringen M Mancini C Patterson B Bennett M Oakman J. A randomized double-blind placebo-controlled trial of olanzapine in the treatment of trichotillomania. J Clin Psychiatry. 2010; 71:1336-1343.

  • 29. Bloch MH Panza KE Grant JE Pittenger Ch Leckman JF. N-Acetylcysteine in the Treatment of Pediatric Trichotillomania: A Randomized Double-Blind Placebo-Controlled Add-On Trial. Journal of the American Academy of Child & Adolescent Psychiatry 2013; 52 (3): 231-240

  • 30. Flessner ChA Penzel F Keuthen NJ Trichotillomania Learning Center–Scientific Advisory Board. Current Treatment Practices for Children and Adults With Trichotillomania: Consensus Among Experts. Cognitive and Behavioral Practice 2010;17: 290–300

  • 31. Colomb R Franklin M Grant JE Keuthen NJ Mansueto CS Mou-ton-Odum S. iwsp. Expert consensus treatment guidelines for tri-chotillomania skin picking and other body-focused repetitive behaviors.2011; http://www.trich.org/dnld/ExpertGuidelines_000.pdf [dostęp: 06.12.2015].

  • 32. Keuthen N.J. Stein D.J. Christenson G.A.: Help for hair-pullers. Oakland Harbinger Publications 2001

  • 33. Płużek Z. Wartość testu WISKAD-MMPI dla diagnozy różnicowej w zakresie nozologii psychiatrycznej. Katolicki Uniwersytet Lu-belski Lublin 1976.

  • 34. Martowska K.: Lista Przymiotnikowa ACL. Polska adaptacja: Zespół Pracowni Testów Psychologicznych PTP Warszawa 2012.

  • 35. Sacks J. Levy S.: The Sentence Completion Test. Projective Psy-chology: Clinical Approaches to the Total Personality. Edited by Abt L. E. Bellak. L. New York: Alfred A. Knopf Inc. 1950. Polskie tłumaczenie: M. Choynowski 1961.

  • 36. Matczak A Piotrowska A Ciarkowska W.: WISC-R. Skala Inteligencji Wechslera dla Dzieci. Wersja Zmodyfikowana. Wydanie trzecie poprawione. Zespół Pracowni Testów Psychologicznych PTP Warszawa 2008.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 419 179 5
PDF Downloads 204 101 3