Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders.

Body-focused repetitive behaviours (BFRBs) are recurrent, compulsive, destructive behaviours directed towards the body. Although studies have demonstrated a 12-14% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRB disorders (BFRBDs) such as trichotillomania (TTM). There is limited research about treatments including ones investigating the clinical applications of various self-help training such as decoupling (DC) and DC in sensu (DC-is) as well as about habit-reversal training (HRT). HRT is a five-component behavioural intervention that aims to develop a competing response to a specific unwanted behaviour. Studies have found substantial support for HRT's efficacy in treating a variety of maladaptive repetitive behaviours including onychotillomania, TTM, skin-picking disorder and chronic cheek biting. Additionally, many psychotherapies can augmented HRT. Psychotherapies include acceptance and commitment therapy, dialectical behaviour therapy, psychodynamic psychotherapy, mindfulness mediation and the cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, resulted in consistently satisfactory objective and subjective improvement for treating BFRBDs, and HRT showed good subjective but poor objective improvement compared with standard DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs; however, further randomized double-blinded and placebo-controlled trials are required to examine HRT's therapeutic profile.

Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial.

Given the limited treatment options for trichotillomania (TTM), or Hair Pulling Disorder, this large randomized clinical trial evaluated the efficacy of acceptance-enhanced behavior therapy for TTM (AEBT-TTM) in reducing TTM severity relative to psychoeducation and supportive therapy (PST). Eighty-five adults (78 women) with TTM received 10 sessions (over 12 weeks) of either AEBT-TTM or PST. Independent evaluators masked to treatment assignment assessed participants at baseline (week 0), midpoint (week 6), and endpoint (week 12). Consistent with a priori hypotheses, 64% of the adults treated with AEBT-TTM were classified as clinical responders at post-treatment relative to 38% treated with PST. Clinical responders were identified by a score of 1 or 2 on the Clinical Global Impressions-Improvement (CGI-I) scale. Relative to the PST group, the AEBT-TTM group demonstrated significantly greater pre-to post-treatment reductions on the self-report Massachusetts General Hospital-Hairpulling Scale (MGH-HS) and the evaluator-rated National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). There were no significant post-treatment group differences on the Clinical Global Impressions-Severity (CGI-S) scale, or rate of TTM diagnoses. Results suggest AEBT-TTM provides greater treatment benefit than PST. Future research should continue to investigate AEBT-TTM along with mediators and moderators of its efficacy.

Role of vitamin D in hair loss: A short review.

BACKGROUND: Vitamin D, a vitamin and hormone, plays an important role in dermatology and dermatotherapeutics, due to its anti-inflammatory and immunomodulatory properties, and regulation of keratinocyte differentiation and proliferation. It also affects the hair cycle, and its role in hair loss is under constant research. OBJECTIVES: This review aims to give a brief overview of vitamin D biology within the hair follicle, role in the etiopathogenesis, and rationale for supplementation in various alopecias. METHODS: A PubMed literature search was performed to review relevant current literature and studies investigating the role of vitamin D in the etiopathogenesis, as a supplement and a potential therapeutic modality in hair loss. RESULTS AND CONCLUSION: Vitamin D is intricately involved in various signaling pathways of growth and differentiation of hair follicles. Most studies show an inverse relationship between serum vitamin D levels and non-scarring alopecias such as telogen effluvium, androgenetic alopecia, alopecia areata, and trichotillomania. Vitamin D deficiency is also associated with scarring alopecia. However, conclusive studies to demonstrate the benefit of vitamin D administration in correcting hair loss and managing these conditions are lacking. Hence, further studies are needed before vitamin D can be routinely recommended as a treatment modality in these conditions.

Personality traits and their clinical associations in trichotillomania and skin picking disorder.

BACKGROUND: Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations. AIM: The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both. METHODS: Adults (n = 98, aged 18-65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined. RESULTS: In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress. DISCUSSION: Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.

Habit reversal therapy in the management of body focused repetitive behavior disorders.

Body-focused repetitive behavior disorders are a group of disorders characterized by repetitive actions that include skin picking, hair pulling, nail biting, and other compulsions. These disorders can range from a common habit to a pathological disorder, that negatively impacts the psychiatric health and social well-being of an individual. Diagnosis can be made clinically, and monitored using different scales and assessments. Various treatments have been tried with differing successes. There are currently no first line curative medications for these disorders, but cognitive behavioral therapy has seen the most success in treatment. Specifically habit reversal therapy has shown the most promise in reducing the repetitive behaviors and symptoms seen in these disorders. Habit reversal therapy has also seen success through augmentation with additional therapies such as mindfulness, or treatment with a selective serotonin reuptake inhibitor in a patient with comorbid obsessive compulsive disorder. This paper aims to explore the efficacy of different treatment modalities specifically the effectiveness and approach of habit reversal therapy.

Pediatric trichotillomania: Review of management.

Trichotillomania can present in childhood, with many families seeking initial evaluation by a dermatologist for hair loss. Prompt and accurate diagnosis by dermatologists is crucial, as children can suffer from academic or social impairments as well as mental health sequelae. Children are especially vulnerable to lasting psychological distress from appearance-related bullying. This article reviews the psychosocial impacts of pediatric trichotillomania and the current interventions studied in this population. Included are studies evaluating behavioral therapies as well as pharmacologic options. This review highlights the importance of early and appropriate identification, intervention, and the need for more treatment studies in the pediatric population.

Milk Thistle Treatment for Children and Adults with Trichotillomania: A Double-Blind, Placebo-Controlled, Crossover Negative Study.

BACKGROUND: Data on the pharmacological treatment of trichotillomania are limited. Milk thistle has antioxidant properties and showed promise in trichotillomania in a prior case report. The goal of the current study was to determine the efficacy and tolerability of silymarin in children and adults with trichotillomania. METHODS: Twenty individuals (19 [95.0%] women; 16 adults; mean age, 27.9 [11.5] years) with trichotillomania entered a 12-week, double-blind, placebo-controlled crossover study (6 weeks of milk thistle and 6 weeks of placebo with a 1-week wash-out in between). Dosing of milk thistle ranged from 150 mg twice a day to 300 mg twice a day. Subjects were assessed with the National Institute of Mental Health Trichotillomania Severity Scale (primary outcome), the Massachusetts General Hospital Hair Pulling Scale, Clinical Global Impression scale, and measures of depression, anxiety, and psychosocial functioning. Outcomes were examined using linear mixed models with a random intercept for subject and t tests. RESULTS: There were no statistically significant treatment type-by-time interactions for the main outcome measure, but significant effects were seen for secondary measures (eg, time spent pulling per day for the past week). From baseline to week 6, there was a significant decrease in Clinical Global Impression severity for the milk thistle group but not in the placebo group. CONCLUSIONS: This trial failed to show that milk thistle was more effective than placebo on the main outcome measure, but milk thistle did demonstrate significant improvements on select secondary outcome measures. These findings may shed light on important neurochemical targets worthy of future investigation.

Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder.

Recommendations are provided for the assessment and treatment of trichotillomania (hair pulling disorder, or HPD) and excoriation disorder (skin picking disorder, or SPD), two body-focused repetitive behavior (BFRB) disorders, based on their severity, comorbidities, and behavioral style. Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels and may be particularly helpful when pulling or picking is performed with lowered awareness/intention. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) are behavioral treatments that can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking. There are currently no FDA-approved pharmacologic treatments for HPD or SPD, though certain medications/supplements have shown varying degrees of efficacy in trials. N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile. Other pharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs), should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure.

Rapunzel syndrome: an infrequent cause of severe iron deficiency anemia and abdominal pain presenting to the pediatric emergency department.

BACKGROUND: Iron deficiency anemia (IDA) and abdominal pain are commonly seen in a pediatric emergency department (8 and 18% incidence respectively in our center). They are manifestations of a wide variety of diseases ranging from benign to immediately life-threatening. Trichobezoar is an under-diagnosed entity that has to be considered in children and adolescents, expecially female, suffering from trichotillomania (compulsion to pull hair) and trichophagy (compulsion to swallow hair). When undiagnosed, gastric bezoars may cause gastric ulceration, perforation, haemorrhage and obstruction. CASE PRESENTATION: To underline the importance of including this pathology in the differential diagnosis of IDA and abdominal pain, we present the case of a 14 year-old girl with a huge trichobezoar which completely filled the stomach and extended into the small bowel. Since trichobezoar has an extension to the small bowel, it is classified as Rapunzel syndrome. As the bezoar couldn't be removed by endoscopy, the girl underwent surgical intervention. The patient passed through a gradual re-feeding, with iron and vitamins supplementation, and through a psychiatric counselling. CONCLUSION: The Rapunzel syndrome is a rare entity that may be complicated by life-threatening events. A prompt diagnosis and an appropriate therapy can reduce comorbidities. Gradual re-feeding with supplementation of micronutrients allows adequate catch-up weight with normalization of haematochemical nutritional parameters. Since many of these patients suffer from psychiatric pathology such as PICA with emotional problems and mental retardation, psychological/psychiatric counselling plays an important role in order to prevent bezoar recurrence.

A Preliminary Investigation of Metacognitive Therapy and Habit Reversal as a Treatment for Trichotillomania.

BACKGROUND: Not all patients suffering from trichotillomania (TTM) recover completely using CBT and of those that do, only a few maintain their recovery over time. AIMS: The purpose of the present study was to investigate the effectiveness of metacognitive methods combined with habit reversal (MCT/HRT) in trichotillomania with a relatively long-term follow-up. METHOD: A case series (n = 8) and a randomized wait-list controlled trial (n = 34) design were conducted in this study. In the case series, three of the eight patients dropped out of the study. Therefore, TTM-related symptoms were evaluated in five patients suffering from TTM before and after brief metacognitive plus habit reversal therapy during 1-month, 6-month, and 12-month follow-ups. The treatment consisted of detached mindfulness (DM) techniques, ritual postponement and habit reversal training (HRT) in eight sessions. RESULTS: All patients were responders at post-treatment in case series. After the 12-month follow-up, the results were associated with higher pre-treatment levels of self-esteem and global functioning and lower pre-treatment levels of depression and anxiety with nearly complete abstinence from hair pulling immediately after treatment. A randomized wait-list controlled trial with experimental (n = 17) and waiting list group (n = 17) was then conducted to confirm the case series results. There were significant differences between the two groups regarding changes in MGH-HPS, Y-BOCS-TM, RSES, GAF, BDI, BAI and self-monitoring. Therefore, the MCT/HRT treatment was found to be more effective than the waiting list group. CONCLUSIONS: A combined treatment including metacognitive and habit reversal techniques is remarkably effective in patients with TTM.

Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update.

Context • Excoriation (skin picking) disorder is characterized by the need or urge to pick, scratch, pinch, touch, rub, scrub, squeeze, bite, or dig the skin, and it can be a perplexing condition for the inexperienced physician. Treatments include pharmacotherapy, psychotherapy, and alternative therapies. Alternative therapies for excoriation disorder and other body-focused repetitive behaviors include yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine, among others. Objective • This review article intended to review the current literature on the alternative therapies to provide a brief update on their benefits for the treatment of excoriation disorder for use in conjunction with psychotherapy and pharmacotherapy in the management of a challenging group of patients. Design • This review (focusing on literature published in the last 15 y, selected from a search of PubMed) critically considers the evidence for the use of alternative therapies in the treatment of excoriation disorder. Setting • This review was conducted at the National University of Asunción (San Lorenzo, Paraguay). Results • Results for yoga were as follows: This technique may influence the structure and functioning of the areas of emotional processing involved in the pathophysiology of excoriation disorder and other body-focused repetitive behaviors, such as trichotillomania. Although still limited, the current research team's use of yoga as a treatment has given useful results. Results for aerobic exercise were as follows: People suffering from excoriation disorder and other-body focused repetitive behaviors generally have a worsening of their behaviors in times of negative mood and anxiety. As exercise has qualities that allow individuals to improve their mood and reduce their anxiety, it is likely that it also can help reduce behaviors like hair pulling or scratching, and it should be considered to be an adjunctive therapy. Results for acupuncture were as follows: The mechanism of action of acupuncture increases serotonergic activity and releases endorphins in the hypothalamus and limbic region, which could be beneficial in patients with trichotillomania and excoriation disorder. Results for biofeedback were as follows: Several case reports have suggested the value of biofeedback in reducing tics, which bear some psychophysiological similarities to body-focused repetitive behaviors, such as trichotillomania and excoriation disorder. Results for hypnosis were as follows: When used as a channel for other types of interventions, such as psychotherapy, hypnosis can help counteract the stress that triggers the picking behaviors in some patients. Results for inositol and N-acetylcysteine were as follows: Although more research is needed, these are promising drugs that may be helpful in reducing the picking behavior. Conclusions • The review indicates that yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine all show promise in the treatment of excoriation disorder and other body-focused repetitive behaviors, such as trichotillomania. In the current research team's experience, mainly yoga and aerobic exercise have been shown useful in combination with psychotherapy and pharmacotherapy. Obtaining solid evidence about the long-term beneficial effects of these alternative therapies for the treatment of excoriation disorder requires more investigation.

Tricobezoar. reporte de caso / Tricobezoar - case report / Trichobezoar - estudo do caso

El Tricobezoar es la acumulación de pelo en el tracto gastrointestinal generalmente asociado a trastornos psiquiátricos que conlleva a sintomatología obstructiva, deficiencias metabólicas y puede llevar a perforación intestinal, pancreatitis, intususcepción y colangitis. Caso: Paciente femenina de 11 años con cuadro clínico de 1 semana de evolución de dolor abdominal en epigastrio asociado a ausencia de deposiciones y antecedente de cuadro similar hace 2 semanas que resolvió con enema oral, se documentó Tricobezoar de 13 x 5 cm que generaba gran distensión en asas intestinales que fue removido por laparotomía con éxito. Conclusiones: Es una patología poco común asociada a un trastorno psicológico, que debe ser manejada quirúrgicamente en pro de prevenir complicaciones e incluye un tratamiento conjunto con psiquiatría y psicología para evitar recurrencias.

The Trichobezoar is the accumulation of hair on the gastrointestinal tract associated with psychiatric disorders generally leading to obstructive symptoms, metabolic deficiencies and, in some cases, intestinal perforation, pancreatitis, cholangitis or intussusception. Case: 11 years old female patient with clinical symptoms of 1 week duration of epigastric abdominal pain associated with bowel movements, patient referred history of similar symptoms two weeks ago that resolved with oral enema, tomography revealed a Trichobezoar 13 x 5 cm generating large strained bowel loops which was successfully removed by laparotomy. Conclusions: Trichobezoar is a rare entity associated with a psychological disorder that needs to be handled surgically towards preventing complications and includes a set psychiatric and psychological treatment to prevent recurrences

Trichobezoar é o acúmulo de pêlos no trato gastrointestinal associado com transtornos psiquiátricos geralmente levando a sintomas obstrutivos, deficiências metabólicas e, em alguns casos, perfuração intestinal, pancreatite, colangite ou intussuscepção. Caso: Paciente do sexo feminino com 11 anos de idade com sintomas clínicos de 1 semana de duração da dor abdominal epigástrica associada a movimentos intestinais, paciente relatou história de sintomas semelhantes há duas semanas que resolveram com enema oral, a tomografia revelou um tricobezoar de 13 x 5 cm, foi removido com sucesso por laparotomia. Conclusões: Trichobezoar é uma entidade rara associada a um transtorno psicológico que precisa ser tratado cirurgicamente para prevenir complicações e inclui um conjunto de tratamento psiquiátrico e psicológico para prevenir recorrências

Tricotilomanía: tratamiento psicodinámico de un caso / Trichotillomania: a case study in psychodynamic treatment / Tricotil·lomania: tractament psicodinàmic d’un cas

Se presenta la psicopatología de la tricotilomanía y otras conductas repetitivas centradas en el cuerpo, así como las claves de su tratamiento a través de la psicoterapia psicoanalítica breve aplicada a un caso. Se obtienen varias conclusiones: la paciente tricotilomaníaca, a pesar de aparentar baja mentalización, muestra una actividad imaginaria que permite el acceso al análisis de sus sueños; la fijación a un conflicto oral reprimido, que atañe al proceso arcaico de separación, formación del yo y diferenciación psique/soma, es el núcleo principal del trastorno; para el acceso y elaboración de los contenidos inconscientes es importante un trabajo terapéutico sobre la diada madre-hija (AU)

The psychopathology of trichotillomania and other repetitive behaviors focused on the body is presented. We describe the keys to their treatment, through a brief process of psychoanalytic psychotherapy applied to a case. Several conclusions are reached: the trichotillomaniac patient, despite appearing to have a low degree of mentalization, displays imaginary activity that allows for access to the analysis of his or her dreams; the fixation on a repressed oral conflict, associated with the archaic process of separation (on formation of the Ego and of the psyche / soma differentiation), is the core of this disorder; in order to help the patient access and process unconscious contents, it is important to undertake therapeutic work on the mother-daughter dyad (AU)

Es presenta la psicopatologia de la tricotil·lomania i altres con­ductes repetitives centrades en el cos, així com les claus del seu tractament mitjançant la psicopatologia psicoanalítica breu aplicada a un cas. S’obtenen diverses conclusions: la pacient tricotil·lomaníaca, tot i aparentar baixa mentalització, mostra una activitat imaginària que permet l’accés a l’anàlisi dels seus somnis; la fixació a un conflicte oral reprimit, que pertoca al procés arcaic de separació, formació del jo i diferenciació psique/soma, és el nucli principal del trastorn; per l’accés i l’elaboració dels continguts inconscients, és important un treball terapèutic sobre la díada mare-filla

Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation.

BACKGROUND: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention 'decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support. METHODS: One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted. RESULTS: Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial x03B7;2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses. CONCLUSIONS: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.

Tricotillomania: pathopsychology theories and treatment possibilities.

The phenomenon of hair pulling has been recognized for centuries, yet the true prevalence of trichotillomania (TTM) is largely unknown and the topic has been sparsely studied. TTM is classified as an impulse-control disorder despite much debate about its etiology. In this review we summarize the different hypotheses, including impulse-control disorders, obsessive-compulsive disorders, behavioral problems and addiction, and the appropriate treatment methods. The combination of selective serotonin reuptake inhibitors and antipsychotic medications are shown to be most effective. Treatment with anti-addiction drugs seems relevant. Further research is needed to increase our knowledge regarding the etiology of TTM.

DBT-enhanced habit reversal treatment for trichotillomania: 3-and 6-month follow-up results.

BACKGROUND: Maintenance of gains with cognitive-behavioral treatment for trichotillomania (TTM) has historically been problematic. METHODS: We conducted follow-up assessments 3 and 6 months after completion of a 3-month maintenance phase on 10 individuals with DSM-IV-TR TTM who participated in an open trial of a dialectical behavior therapy (DBT)-enhanced habit reversal treatment (HRT). RESULTS: Significant improvement from baseline was reported at 3-and 6-month follow-up on all measures of hair pulling severity and emotion regulation, although some worsening was reported on some measures from earlier study time points. At 6-month follow-up, five and four participants were full and partial responders, respectively. Significant correlations were reported at both follow-up time points between changes in hair pulling severity and emotion regulation capacity. CONCLUSIONS: DBT-enhanced HRT offers promise for improved long-term treatment results in TTM. Changes in TTM severity from baseline to 3-and 6-month follow-up is correlated with changes in emotion regulation capacity.

Ethnic differences in trichotillomania: phenomenology, interference, impairment, and treatment efficacy.

In this Internet study, we explore differences among minority and Caucasian participants in the phenomenology of, interference and impairment related to, and perceived efficacy of treatments for trichotillomania (TTM) symptoms. A demographic difference was found for number of children only. Results indicate that the minority sample was less likely to report pulling from their eyebrows and eyelashes than the Caucasian sample. Minorities were less likely to report increased tension before a pulling episode. Minorities reported high levels of TTM interference with home management but Caucasians reported higher TTM interference with their academic life. Caucasians with TTM reported higher daily stress than their minority counterparts. Although minorities were less likely to utilize treatment, no significant differences were found for treatment improvement. This Internet study sheds important light on differences in TTM symptoms among minorities and Caucasians. The lack of economic and education differences between groups is a strength of this research.

Trichotillomania in children: the occult truth.

A major emphasis of modern-day pediatric dental care is a holistic approach to children and the importance of treating them as individuals and not merely as patients with mouth diseases. We should not restrict ourselves to the oral cavity alone, but also explore the mind of an individual, for in it lays the hidden clue to successful management. In order to achieve this, we need to meet the mind of the child before meeting the mouth. Surmounting pressure on today's children builds a lot of anxiety in them, and this in turn is the foundation for various psychological problems. One such rare but important psychological disorder is "trichotillomania." The present study is an attempt to provide an insight into this intriguing disorder based on a case report. The signs and symptoms of trichotillomania are discussed, and various management options are outlined.