Trichotillomania with trichobezoars – A case report

BACKGROUND: Trichotillomania or hair-pulling disorder, is a common but under diagnosed psychological disorder, classified under obsessive-compulsive and related disorders in DSM-5.It is characterized by recurrent body focused repetitive behavior (hair-pulling) and repeated attempts to decrease or stop the behavior. The behavior can occur during both relaxed and stressful times, but there is often a mounting sense of tension before hair pulling occurs or when attempts are made to resist the behavior. Less than 10% of those with Trichotillomania develop Trichophasia and it results in Trichobezoar formation. AIMS: To report and discuss a rare case of Trichotillomania with trichobezoars in young female patient. METHODS: Clinical diagnosis as per DSM-5 and necessary investigations were done. RESULTS: A 20 year old female patient was referred from the department of Dermatology. On evaluation she was found to be having classical features of Trichotillomania and Trichophasia with Alcohol abuse. Significant history of physical abuse and conflicts with husband present. X-ray abdomen revealed Trichobezoars in the stomach. Patient was treated with T.Fluoxetine 80mg per day. Reassurance was given and advised Habit reversal technique. Follow up after 30 days showed improvement in her symptoms. CONCLUSION: Trichotillomania is a rare, chronic, and relapsing disorder, with onset in the early teenaged years. It is a disorder that may have significant medical and psychiatric implications. A treatment algorithm bridging the pharmacological and behavioral therapy must be established in order to counteract and approach such cases effectively.