Lifting the Veil on Trichotillomania

Abstract

“Dr. D,” a 32-year-old female general practitioner, presented to a psychiatric referral clinic with a history of repetitive hair pulling since age 14. Recently the hair pulling had escalated, and it now occupied 2–3 hours per day, usually during the evening when Dr. D was relaxing. Despite imaginative efforts to conceal her missing hair and eyebrows, Dr. D felt that she was “fighting a losing battle.” She reported an overpowering urge to touch, select, and pull out particular hairs and described feelings of tension that were only alleviated by the act of hair pulling. This behavior had led to a growing sense of frustration and shame and avoidance of social contact. When asked about her experience with hair pulling in her own medical practice, Dr. D replied that on numerous occasions she had asked patients with unusual scalp patches about deliberate hair pulling and that the patients invariably denied it.