[Trichotillomania as a phenomenon of unexplained loss of hair in childhood (author's transl)]

Abstract

As a contribution to the differential diagnosis of ambiguoug "loss of hair" we forward a report on 24 children and 2 adolescents with trichotillomania. Patients with this pathological habit tear out hair from their own head -- sometimes eyelashes or eyebrows as well -- mostly in unobserved moments. Therefore the diagnosis is frequently delayed for months or even years. Most of these patients have normal intelligence are motorically overactive, and sensitive. They suffer from a lack of selfne assurance, and an inhibition to establish initial social contacts or to give expression to their aggressive tendencies. The manipulation of their own body serves as an outlet for the inner and outer strain resulting form the pressures of a permanent conflict-situation. The calming effect, combined with the apparently highly satisfying physical experience, induced repetition and the development of a fixed habit. In early childhood the factors contributing to the emotional strain are almost always found in a conflicting mother-child relationship, very often against the background of a general deficiency in family interaction. Moreover at school level the symptom occurs most frequently as a result of pressure on the child to achieve more. Trichotillomania has to be considered in children with focal or diffuse alopecia in areas of normal scalp, where almost no hair is lost by combing or gentle pulling. The trichogram gives specific results. Diagnosis must be based on a behaviour analysis and psychodiagnosis of the child. In addition, personal interactions within the family must be investigated. The first goal of therapy is the elimination of the emediate causes through counselling the parents. The improvement of the child's ability to communicate is essential. Depending on the age of the child the approach to the treatment of the social disturbances through psychotherapy or medical pedagogy should be combined with a symptom--centered treatment through behaviour therapeutical techniques with the aim of eliminating this fixed habit.