Trichomania

trichomania.

See trichotillomania.

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Trichotillomania

The compulsive pulling out of one's own hair—formally, chronic traction alopecia—to the point that it is noticeable and causing significant distress or impairment. It affects up to 2.5 million in the US, begins in childhood, and is more common in girls—female:male ratio is 8:1 in pre-adolescents and 3:1 in adults—peaking at age 12–13; it is a disorder of impulse control, linked to tics, and habit disorders—e.g., thumb-sucking—and attributed to unresolved psychodynamic conflicts, low self-esteem, stress, anxiety, depression
DiffDx Alopecia areata, tinea capitis, traction alopecia, loose anagen syndrome
Complications Patchy alopecia, suppurative dermatitis, permanent loss of hair, repetitive stress injury, carpal tunnel syndrome, gastrointestinal obstruction due to trichophagia, which begets trichobezoars
Management Hypnosis, behaviour modification, psychotherapy, IMAOs, amitriptyline, etc. have been tried with varying degrees of success; tricyclic antidepressants—e.g., clomipramine—may be effective short-term