Trichotillomania in Childhood: A Case of Successful Short-Term Treatment

Trichotillomania (compulsive hair pulling) in children is a complex symp-tom for which no single psychodynamic conceptualization has yet been identified. An important predisposing factor for this symptom appears to be an inconsistent, depriving relationship between mother and child. Some therapists have applied the concept of the "transitional " (soothing) object in treating young children with this disorder. A case of a 5-year-old retarded boy is presented in which hair pulling occurred in response to psychological trauma (threatened loss of and/or injury to a beloved grandfather). Treatment was carried out through the mother and consisted of her clarifying the traumatic events and the child's anxious and angry feelings about them. Child psychologists and pediatricians, as primary care-givers, should be aware that hair pulling can represent a traumatic neurosis and should take a careful psychosocial history before instituting any physical treatment or referring on to a dermatologist. The subject of children with compulsive hair pulling (trichotillomania) has been addressed infrequently in both pediatric and psychiatric literature. To date, no clear conceptualization of the symptom or the psychodynamics in-volved in its development has emerged. Compulsive hair pulling is reported to occur in children of widely varying ages, seems to appear more frequently in girls than in boys, and often appears in combination with other psy-chological disorders. Kanner (1972) lists hair pulling under habitual mani-pulations of the body and implies that it often occurs in mentally retarded children. Monroe and Abse (1963) suggest that specific trauma to the scalp is an important predisposing factor in determining the choice of symptom, but scalp trauma is not frequently reported in the literature