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ABSTRACT Background Methods Results Conclusions Trichotillomania (TTM) significantly increases the risk of psychiatric comorbidities. Sparse research in pediatric populations necessitates larger studies to assess these risks. This study investigates the risk of developing psychiatric comorbidities in pediatric TTM patients.This case–control study assessed pediatric patients (< 18 years old) with TTM diagnosed between May 18, 2013, and January 1, 2024, using US‐based data from the TriNetX global research network. TTM patients (ICD‐10 diagnostic category F63.3) aged 18 years or younger at diagnosis and control patients (ICD‐10 code Z00.129) matched for age, sex, race, and ethnicity were assessed. Propensity score matching yielded 16,590 patients in each cohort. The analysis assessed subsequent diagnoses of ADHD, conduct disorders, tic disorders, obsessive‐compulsive disorder, anxiety disorders, dissociative, stress‐related, and somatoform disorders, mood disorders, and suicide attempts compared to controls.TTM patients under 18 years exhibited significantly greater risks of subsequent diagnoses for ADHD (OR: 2.002; CI 1.841–2.178; p < 0.001), conduct disorders (OR: 3.668; 3.2–3.668; p < 0.0001), tic disorders (OR: 2.247; 1.826–2.765; p < 0.0001), obsessive‐compulsive disorder (OR: 11.047; 8.822–13.832; p < 0.0001), anxiety disorders (OR: 3.583; 3.387–3.7; p < 0.0001), dissociative, stress‐related, and somatoform disorders (OR: 6.179; 3.935–9.701; p < 0.0001), mood disorders (OR: 2.476; 2.288–2.68; p < 0.0001), and suicide attempts (OR: 1.81; 1.121–2.924; p = 0.0139) compared to controls. TTM patients had the greatest risk of psychiatric diagnosis 1 year postindex event.Pediatric TTM patients have higher psychiatric comorbidity risks, necessitating timely intervention and comprehensive management. Dermatologists can facilitate access to behavioral and pharmacological care, enhancing patient outcomes. [ABSTRACT FROM AUTHOR]

Trichotillomania is a debilitating and chronic condition involving repeated hair pulling from various areas of the body. Trichotillomania often begins in childhood, suggesting that the development and understanding of treatments for trichotillomania in youth are of utmost importance, especially for successful early intervention. While habit reversal training (HRT) is considered the gold standard treatment for trichotillomania in young people, this article reviews a nascent treatment approach for trichotillomania in youth, acceptance-enhanced behavior therapy (AEBT). AEBT combines HRT and acceptance and commitment therapy skills. Each component of AEBT is described and reviewed. A detailed case exemplar of the 10-session protocol is presented. Future research directions and important clinical considerations are discussed. [ABSTRACT FROM AUTHOR]

Objective: Body-focused repetitive behaviors (BFRBs) such as skin-picking, trichotillomania, nailpicking, nail-biting, lip-biting and skin-biting have adverse physical and psychological effects. This study aimed to investigate the prevalence and associated factors of BFRBs in a sample of Turkish medical students. Material and Methods: An online survey was used to investigate the prevalence of six BFRBs — skin-picking, trichotillomania, nail-biting, nail-picking, lip-biting and skin-biting-- and psychological factors such as anxiety, depression, stress levels, impulsivity and difficulties in emotional regulation (DER) in a sample of 200 medical students. Skin Picking Scale-Revised (SPS-R), Massachusetts General Hospital Hairpulling Scale (MGH-HPS), Depression Anxiety Stress Scales-21 (DASS-21), Barratt Impulsiveness Scale–Short Form and Difficulty in Emotion Regulation Scale—Brief Form were applied, and specific questions for investigating four BFRBs (nail-picking, nail-biting, lip biting and skin biting) were administered. Results: The prevalence of at least one BFRB disorder was 28.0% (n=56). The most common diagnoses were skin-picking (17.0%) and trichotillomania (10.5%), followed by skin-biting (9.0%), lip biting (8.5%), nail-picking (7%) and nail-biting (5.0%). The gender difference was found only in skin-picking disorders (females=22.9%; males=8.5%). Students with BFRB disorder were found to have higher levels of anxiety, depression, stress, impulsivity and DER. Students in 2nd, 3rd and 5th grade are more likely to have BFRB disorders than interns. The mediation model indicated that DER partially mediates the relationship between impulsivity and the BFRB disorder. Conclusion: The findings of the study suggest that BFRBs are common among medical students and that these behaviors are associated with psychological factors such as depression, anxiety, stress levels, impulsivity and difficulties in emotion regulation. Screening programs and intervention strategies for BFRBs in medical students should be developed, and it is recommended that psychological factors should be considered in these interventions, emotion regulation and stress management skills should be significantly improved, and comorbid depression and anxiety should be treated. [ABSTRACT FROM AUTHOR]

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Abstract Background Body‐focused repetitive behaviours (BFRBs), such as skin picking and trichotillomania, are conditions at the interface of dermatology and psychiatry. Objectives We asked individuals with various BFRBs about their habits and preferences preceding the onset of their BFRB(s). We also inquired about the emotions (positive, negative or mixed) accompanying the habit to explore predisposing and maintenance factors. Methods A sample of 201 individuals with mixed BFRBs were recruited online. We administered the Generic BFRB Scale (GBS‐36) and the newly developed Somatic and Habitual Predisposition to BFRB Scale as well as the Ambivalence Towards BFRB Rating. Results Most participants reported both positive and negative feelings towards engaging in BFRBs, with only a minority (41.8%) indicating predominantly negative feelings. The study speaks to somatic and habitual predisposing factors that are topographically related to specific conditions (e.g., dislike of one's skin and skin impurities preceding skin picking, dislike of one's nails and brittle nails preceding nail biting, tendency to scarring and injuries preceding lip‐cheek biting). Conclusions Our study speaks to important somatic and habitual predisposing factors in BFRBs. Positive feelings accompanying BFRBs may act as an important maintenance factor in BFRBs. Our results may inform new therapeutic approaches to treating or preventing BFRBs.

To examine the prevalence of trichotillomania (TTM) and associated factors in a large non-clinical sample of Turkish university students. The population of the study comprised 862 university students, 596 (69.1%) females and 266 (30.9%) males, aged between 18 and 29 (21.3 ± 1.8) years. In addition to a sociodemographic form, the participants completed the Massachusetts General Hospital Hairpulling Scale and the Brief Symptom Inventory, and the Structured Interview Form based on the DSM 5 criteria for TTM. In the study, lifetime hair-pulling behavior was found in 18.9% of university students, current hair-pulling behavior was found in 10%, and a current diagnosis of TTM was found in 2.3%. The ratio of men to women among those diagnosed as having TTM was determined to be 1.8:1. Women mentioned more stressors that triggered hair-pulling behavior than men. Women showed hair-pulling behavior to reduce tension, whereas men reported that they experienced more pleasure sensations during hair-pulling. Finally, it was determined that those who met the TTM diagnostic criteria showed more persistent pulling patterns, felt more regret, and social avoidance, attempted to camouflage more, and thought their behavior was more likely to be a psychiatric illness than those who did not meet the TTM diagnostic criteria. Unlike the literature, the prevalence of TTM in Turkish university students was found to be almost equal in men and women, but it was determined that the hair-pulling patterns of men and women differed. Therefore, it is thought that rather than sex being a risk factor for TTM, it may differentiate approaches of men and women to hair-pulling and help-seeking behaviors. [ABSTRACT FROM AUTHOR]

Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one's hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna's case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members' beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania. [ABSTRACT FROM AUTHOR]

Aim: Trichotillomania, an obsessive-compulsive-related disorder, is defined by the recurrent act of pulling out one's own hair from different areas of the body. Despite the considerable body of research dedicated to the subject of trichotillomania, the overarching trends that unify these studies remain obscure. The purpose of the present bibliometric analysis was to ascertain these trends. Method: To achieve this objective, we conducted a thorough search of publications in the Web of Science database and subsequently evaluated the acquired data using VOSviewer software. Results: The most cited article on trichotillomania was written by Simonoff et al. The most prolific writer on trichotillomania is Grant JE. The most publications on the subject of trichotillomania were published in the "Journal of Obsessive Compulsive and Related Disorders" and the most frequently repeated keyword is trichotillomania. Trichotillomania studies have focused on treatment, clinical features, and other accompanying psychiatric conditions. Conclusion: Potential areas of research could include treatment methods in addition to the psychiatric and physical comorbidities of trichotillomania, and efforts to enhance international collaborations in this domain should be intensified. [ABSTRACT FROM AUTHOR]

Background: Trichotillomania and skin picking disorder have been characterized as body-focused repetitive behavior (BFRB) disorders (i.e., repetitive self-grooming behaviors that involve biting, pulling, picking, or scraping one's own hair, skin, lips, cheeks, or nails). Trichotillomania and skin picking disorder have also historically been classified, by some, as types of compulsive self-injury as they involve repetitive hair pulling and skin picking, respectively. The question of the relationship of these disorders to more conventional forms of self-injury such as cutting or self-burning remains incompletely investigated. The objective of this study was to examine the relationship of these two disorders with non-suicidal self-injury (NSSI). Methods: Adults with trichotillomania (n = 93) and skin picking (n = 105) or both (n = 82) were recruited from the general population using advertisements and online support groups and completed an online survey. Participants completed self-report instruments to characterize clinical profiles and associated characteristics. In addition, each participant completed a mental health history questionnaire. Results: Of the 280 adults with BFRB disorders, 141 (50.1%) reported a history of self-injury independent of hair pulling and skin picking. Participants with a history of self-injury reported significantly worse pulling and picking symptoms (p  < .001) and were significantly more likely to have co-occurring alcohol problems (p  < .001), borderline personality disorder (p  < .001), buying disorder (p  < .001), gambling disorder (p  < .001), compulsive sex behavior (p  < 001), and binge eating disorder (p  = .041). Conclusions: NSSI appears common in trichotillomania and skin picking disorder and may be part of a larger constellation of behaviors associated with impulse control or reward-related dysfunction. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusions\nKey PointsUntil recently, empirical studies had been limited with respect to investigating factors that influence the onset and maintenance of hair pulling disorder (HPD), particularly regarding the role of dysfunctional cognitions and beliefs. The primary aim of this study was to examine the relationships between symptom severity and belief domains in a sample with hair pulling disorder compared with non-clinical participants, using the Beliefs in Trichotillomania Scale (BiTS); a recently developed measure of relevant negative self-beliefs, coping efficacy beliefs, and perfectionist cognitions.Twenty adults with HPD and 43 age- and gender-matched control participants completed the BiTS and several measures of related constructs.HPD severity was significantly and positively correlated with negative self-beliefs and low coping efficacy, but not perfectionism, even after controlling for anxiety and depressive symptoms. Focussed hair pulling, but not automatic hair pulling, was correlated with each BiTS domain; however, once anxiety and depressive symptoms were controlled for, the significant relationship between focussed hair pulling and perfectionism was no longer apparent. The BiTS psychometric properties demonstrated good internal consistency and differentiated clinical from non-clinical participants, with clinical participants endorsing greater negative self-beliefs, lower coping efficacy, and greater perfectionism compared with control participants.Negative self beliefs, low coping efficacy, and perfectionism have differential relationships with HPD severity and hair pulling styles, variable on the presence of co-occurring anxiety and depressive symptoms. While further support for the BiTS internal consistency was obtained, future examination of divergent validity with a more diverse range of constructs is required.What is already known about this topic: Current cognitive-behavioural interventions for hair pulling disorder are designed to facilitate behaviour change by targeting the habit-formation and emotion-regulation mechanisms that maintain hair pulling behaviours.The Beliefs in Trichotillomania Scale (BiTS) measures three belief domains found to be relevant to hair pulling disorder: negative self beliefs, low coping efficacy, and perfectionism.Some cognitive-behavioural interventions additionally target cognitions and beliefs, however, few studies have investigated the relationships between relevant belief domains and hair pulling disorder severity and styles.Current cognitive-behavioural interventions for hair pulling disorder are designed to facilitate behaviour change by targeting the habit-formation and emotion-regulation mechanisms that maintain hair pulling behaviours.The Beliefs in Trichotillomania Scale (BiTS) measures three belief domains found to be relevant to hair pulling disorder: negative self beliefs, low coping efficacy, and perfectionism.Some cognitive-behavioural interventions additionally target cognitions and beliefs, however, few studies have investigated the relationships between relevant belief domains and hair pulling disorder severity and styles.What this topic adds: Independent of co-occurring anxiety and depressive symptoms, negative self beliefs and low coping efficacy, but not perfectionism, were associated with hair pulling severity.Negative self beliefs, doubts about one’s coping efficacy, and perfectionism were all associated with focussed hair pulling behaviours, but not automatic hair pulling behaviours. However, perfectionism was no longer correlated with focussed hair pulling upon controlling for anxiety and depressive symptoms.Assessment for these domains of dysfunctional beliefs, as part of formulation-driven cognitive-behavioural interventions for hair pulling disorder, is appropriate.Independent of co-occurring anxiety and depressive symptoms, negative self beliefs and low coping efficacy, but not perfectionism, were associated with hair pulling severity.Negative self beliefs, doubts about one’s coping efficacy, and perfectionism were all associated with focussed hair pulling behaviours, but not automatic hair pulling behaviours. However, perfectionism was no longer correlated with focussed hair pulling upon controlling for anxiety and depressive symptoms.Assessment for these domains of dysfunctional beliefs, as part of formulation-driven cognitive-behavioural interventions for hair pulling disorder, is appropriate. [ABSTRACT FROM AUTHOR]

Trichotillomania is a form of impulsive disorder characterized by repetitive, deliberate, and irresistible pulling of one’s own hair resulting in traumatic alopecia that is commonly seen in children. It has a fluctuating course that waxes and wanes in association with a stressful or emotional event. It produces non-scarring alopecia at the onset and if not addressed on time, it may lead to permanent scarring alopecia. In this article, we report a case series of trichotillomania with a review of the literature. [ABSTRACT FROM AUTHOR]

Background: Prevalence estimates for body-focused repetitive behaviors (BFRBs) such as trichotillomania differ greatly across studies owing to several confounding factors (e.g. different criteria). For the present study, we recruited a diverse online sample to provide estimates for nine subtypes of BFRBs and body-focused repetitive disorders (BFRDs). Methods: The final sample comprised 1481 individuals from the general population. Several precautions were taken to recruit a diverse sample and to exclude participants with low reliability. We matched participants on gender, race, education and age range to allow unbiased interpretation. Results: While almost all participants acknowledged at least one BFRB in their lifetime (97.1%), the rate for BFRDs was 24%. Nail biting (11.4%), dermatophagia (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent BFRDs. Whereas men showed more lifetime BFRBs, the rate of BFRDs was higher in women than in men. Rates of BFRDs were low in older participants, especially after the age of 40. Overall, BFRBs and BFRDs were more prevalent in White than in non-White individuals. Education did not show a strong association with BFRB/BFRDs. Discussion: BFRBs are ubiquitous. More severe forms, BFRDs, manifest in approximately one out of four people. In view of the often-irreversible somatic sequelae (e.g. scars) BFRBs/BFRDs deserve greater diagnostic and therapeutic attention by clinicians working in both psychology/psychiatry and somatic medicine (especially dermatology and dentistry). [ABSTRACT FROM AUTHOR]

Self-help may help fill the large treatment gap in individuals with body-focused repetitive behaviors (BFRBs). We examined the efficacy of three self-help techniques for BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) and also tested whether a video demonstration is more efficacious to written instructions. A total of 224 participants with at least one BFRB were randomly assigned to two intervention groups (video, manual) receiving access to all techniques or a wait-list control group (1:1:1). A 6-week follow-up assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale (GBS-9) served as primary outcome. The intention-to-treat analysis showed significant improvements for the manual group compared to the wait-list control group on GBS total score and severity and impairment scores. For the per-protocol analyses (i.e., participants had at least read/watched the manual/video), 26.9% of completers in the manual group improved at least 35% in GBS compared to 23.3% (video group) and 15.9% (control). A dose–response relationship emerged for the video group. Subjective ratings by the video and manual groups did not differ; treatment satisfaction was greater for HRT and DC than for DC-is. Results suggest that the manual group showed somewhat stronger effects than the video group when usage frequency was low. With more frequent usage, improvements in the video condition increased. Future studies should investigate potential order effects of the techniques as well as add-on effects when techniques are used along with other treatment approaches. [ABSTRACT FROM AUTHOR]

Trichophagia, or eating one's own hair, commonly occurs in individuals with trichotillomania. Minimizing the symptoms of trichotillomania and trichophagia and maintaining remission can encourage them to have healthy lives. Conduct a scoping review to investigate the efficacy of using psychotherapy interventions to minimize symptoms of trichotillomania and trichophagia among individuals with trichotillomania. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to screen 19,552 studies published between 2010 and 2022. A total of 19 studies that fulfill the eligibility criteria reported that psychotherapy interventions had been effective and applicable approaches to minimizing the symptoms of trichotillomania and trichophagia. Psychotherapy interventions are a promising treatment that is regarded as a credible treatment approach to ensure long-term positive outcomes among individuals with trichotillomania. This scoping review verifies the formalization and incorporation of psychotherapy interventions into standard practice and highlights the importance of mental health practitioners using them to ensure long-term positive outcomes for individuals with trichotillomania. Moreover, practitioners need further specialized training on a variety of psychotherapy interventions because not all of them are familiar with these interventions. [ABSTRACT FROM AUTHOR]

Introduction: Trichotillomania (TTM) is an obsessive-compulsive disorder characterized by the uncontrollable pulling of hair from various parts of the body, most commonly from the scalp, eyebrows, and eyelashes. Clinical manifestations of TTM include patchy alopecia, uneven hair shaft growth, and characteristic changes visible in trichoscopy, such as the presence of black dots, twisted hairs, split ends, and hairs shaped like exclamation marks. The etiology of TTM is complex and involves genetic, neurological, and psychological factors. In some patients, TTM co-occurs with trichophagia, leading to the formation of trichobezoars in the gastrointestinal tract. In extreme cases, such as Rapunzel Syndrome, bezoars can lead to intestinal obstruction. Treatment for TTM is multifaceted and includes both psychotherapeutic and pharmacological interventions. Objective: The objective of this study is to provide a comprehensive review of trichotillomania (TTM), with a particular focus on its clinical symptoms, etiology, diagnostics, and treatment methods. The aim is to understand this obsessive-compulsive disorder, its impact on patients' lives, and its connections to serious complications such as trichobezoars and Rapunzel Syndrome. Materials and Methods: The study utilized analyses of scientific research, review articles, and reports concerning trichotillomania (TTM), trichobezoars, trichophagia, and Rapunzel Syndrome. It is primarily based on data from PubMed, Google Scholar, Cochrane Library, and studies published between 2000 and 2024, focusing on the diagnostics, etiology, and treatment of TTM and related disorders. Conclusions: The purpose of this study is to provide a comprehensive review of the current knowledge on trichotillomania, including its clinical symptoms, etiology, diagnostics, and treatment methods, while considering serious complications such as trichobezoars and Rapunzel Syndrome.

BackgroundTrichotillomania (TTM) and skin picking disorder (SPD) are common and often debilitating mental health conditions, grouped under the umbrella term of body-focused repetitive behaviors (BFRBs). Recent clinical subtyping found that there were three distinct subtypes of TTM and two of SPD. Whether these clinical subtypes map on to any unique neurobiological underpinnings, however, remains unknown.MethodsTwo hundred and fifty one adults [193 with a BFRB (85.5% [n = 165] female) and 58 healthy controls (77.6% [n = 45] female)] were recruited from the community for a multicenter between-group comparison using structural neuroimaging. Differences in whole brain structure were compared across the subtypes of BFRBs, controlling for age, sex, scanning site, and intracranial volume.ResultsWhen the subtypes of TTM were compared, low awareness hair pullers demonstrated increased cortical volume in the lateral occipital lobe relative to controls and sensory sensitive pullers. In addition, impulsive/perfectionist hair pullers showed relative decreased volume near the lingual gyrus of the inferior occipital-parietal lobe compared with controls.ConclusionsThese data indicate that the anatomical substrates of particular forms of BFRBs are dissociable, which may have implications for understanding clinical presentations and treatment response.

Background Methods Results Conclusions Trichotillomania, also known as hair‐pulling disorder, is a chronic psychiatric condition with a fluctuating course in which an individual pulls out their hair, leading to visible hair loss and psychosocial sequelae. Due to the unknown pathogenesis, the treatment of this disorder is complex and remains a challenge for dermatologists and psychiatrists. Since guidelines for treating trichotillomania are lacking and, consequently, no common treatment strategy exists, we decided to perform a large‐scale, global retrospective cohort study to assess the characterized real‐world prescription patterns in treating trichotillomania.The research used the TrinetX database for patients with trichotillomania (ICD 10 – F63.3) within the European and the United States Collaborative Network (EC and UC, respectively). After consulting with a psychodermatology expert, a list of 25 medications was investigated.Data on the prescription drugs of 1,275 patients from the EC and 109,741 patients from the UC were collected. In both the EC and UC cohorts, benzodiazepine derivatives, particularly lorazepam and midazolam, were the most commonly prescribed sedatives/hypnotics. Antipsychotic prescriptions, primarily haloperidol, followed benzodiazepines. After the trichotillomania diagnosis, notable changes in drug prescriptions for the EC cohort, including an increased likelihood of receiving acetylcysteine, haloperidol, quetiapine, sertraline, olanzapine, and risperidone were observed. The UC cohort showed minimal changes. Overall, both cohorts leaned toward benzodiazepine prescriptions (37% UC, 21% EC) and had limited antidepressant usage. Haloperidol (19.3%) and quetiapine (15.1%) were commonly prescribed in both cohorts.The results of our study indicate that the real‐world prescription patterns for trichotillomania differ significantly from the expert‐proposed therapeutic approach and point toward the necessity of creating standards of pharmacological care and better education. [ABSTRACT FROM AUTHOR]

Purpose: Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. Methods: A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. Results: Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. Conclusion: The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trichotillomania is defined by the DSM-5 as a disorder in which the patient pulls out their hair on a consistent basis, whether it be hair from the scalp, eyebrows, or any other region of their body. It causes significant functional impairment. This disorder is considered among the compulsive obsessive disorders. The areas most frequently affected are scalp, eyebrows, eye lashes and pubic hair. Lifetime prevalence is estimated between 0.6-1%. CLINICAL CASE: A 51-year-old female patient, who had presented symptoms of anxiety for the past 11 years. In the past 4 years symptoms had worsen progressively with compulsive night hair pulling which intensified after social stressors. At external inspection at the frontoparietal area of the scalp we found a localized alopecia with an irregular circumference of approximately 10 cm in diameter, so secondary neuromechanical alopecia was diagnosed. CONCLUSIONS: In several psychopathologies, hair pulling can be a symptom, so a psychiatric consult is very important to evaluate comorbidities and classify the symptom of hair pulling within the clinical picture. Like other dermatoses of psychic origin, the diagnosis of trichotillomania does not imply that these patients should be treated only by the psychiatrist. The Dermatology service plays an important role in hair pulling disorder. [ABSTRACT FROM AUTHOR]

Introduction. Rapunzel syndrome is an uncommon condition that manifests as trichobezoars, which are hair bundles in the stomach or small intestine that can mimics other surgical illnesses. Multiple complications can arise from delayed diagnosis and treatment. Clinical case. A 10-year-old female patient with trichotillomania and trichophagia, with abdominal pain and nonspecific symptoms of intestinal obstruction of eight months of evolution. Physical examination revealed epigastric tenderness and a solid mass was palpable in the mesogastric and epigastric region. An abdominal ultrasound showed gastric trichobezoar that extended into the small intestine. A gastrotomy was performed and the trichobezoar was extracted with satisfactory evolution of the patient. The comprehensive approach allowed knowing the psychological bond due to possible child abuse. Results. The patient had a satisfactory evolution and was discharged on the fifth day of hospitalization. He is currently being monitored by psychology, child psychiatry and pediatrics. Discussion. This clinical case highlights the importance of recognizing situations that seldom present in pediatrics, which may have a psychological aspect due to the presumption of child abuse, and which present as a recurrent organic condition simulating other frequent abdominal pathologies in childhood; all of which may lead to an unwanted outcome due to diagnostic delay. Conclusion. The comprehensive management of the pediatric patient is mandatory to recognize situations of presumed child abuse, in the face of a recurrent surgical conditions. [ABSTRACT FROM AUTHOR]

Background: Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars. Materials and Methods: We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome. Results: Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications. Conclusions: Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome. [ABSTRACT FROM AUTHOR]

• We reported on 63 young people with body-focused repetitive behaviors (BFRB) • BFRB can be severe and cause significant functional impairment. • The effectiveness of habit reversal, plus medication when appropriate, was tested. • This multimodal treatment was effective for young people with BFRB. • Treatment gains were maintained up to 1 year after treatment. Body-focused repetitive behavior disorders, including trichotillomania (hair-pulling disorder) and excoriation (skin picking) disorder, typically emerge in early adolescence, but little is known about the clinical characteristics and treatment outcomes of these disorders in young people, particularly in real-world clinical settings. Participants were 63 children and adolescents (51 girls; age range 9–17) with a diagnosis of trichotillomania (n = 33) and/or skin-picking disorder (n = 33) attending a specialist outpatient clinic in Stockholm, Sweden. Demographic and clinical characteristics were gathered at the initial assessment. Of the 63 assessed youths, 56 received manual-based behavior therapy mainly focusing on habit reversal training, which was combined with medication when deemed appropriate. The mean clinician-reported trichotillomania and skin-picking disorder symptom severity at baseline (n = 63) was in the moderate range. We observed high rates of psychiatric comorbidity (63.5%) and use of psychiatric medication (54.8%). For the 56 individuals undertaking treatment at the clinic, mixed-effects regression models showed a significant decrease in symptom severity from baseline to posttreatment, with gains maintained up to the 12-month follow-up. Substantial and durable improvements were also seen on self-reported symptoms, self-reported depression, and global functioning. Specialist care should be made more widely available to improve the prognosis and quality of life of young people with trichotillomania and skin-picking disorder. [ABSTRACT FROM AUTHOR]

Trichotillomania (TTM) is an intractable and chronic mental disorder that causes significant distress or functional impairments in various life domains. Most individuals with trichotillomania have other comorbid diagnoses. Bipolar disorder (BD) is one of the most common comorbid conditions. Up to date, no FDA-approved drugs for TTM are available, not to mention children and adolescent patients with TTM and BD. Here, we present a case of an 8-year-old child with a long history of episodic TTM and bipolar disorder who was effectively treated with topiramate in a 3-year follow-up. [ABSTRACT FROM AUTHOR]

Although bariatric surgery is an effective method used in the treatment of obesity today, many psychiatric difficulties are detected when patients are evaluated biopsychosocially during the pre-and postoperative periods. Especially when surgery is used in patients with eating disorders, different addiction problems and impulse control disorders may arise afterward. We present a clinical case of a patient with increased obsessive-compulsive symptoms, various impulsive control problems, and bulimia nervosa starting after bariatric surgery. Another feature that made this case interesting was the extrapyramidal adverse effects that occurred after fluoxetine treatment used for her psychiatric treatment. Our aim, thus, was to contribute to the literature by discussing psychiatric problems evolving after bariatric surgery and the rare adverse effect of fluoxetine. [ABSTRACT FROM AUTHOR]

Background: Trichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. Aim: In this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. Method: We systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. Results: Of the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. Conclusions: Our review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.

Trichobezoar is a rare diagnosis among pediatric patients highlighting underlying psychiatric illness. Gastric bezoar with a long tail extending into small bowel may present with varied presentation including small bowel obstruction. Isolated small bowel trichobezoar is rare making diagnosis difficult highlighted in the index case.

Introduction: Psychocutaneous disorders in children have been a gray zone in dermatology practice. It can be secondary to some primary dermatological disorder or can be a presentation of underlying primary psychiatric illness. There is a paucity of data regarding the occurrence of these disorders in the pediatric population. The present study was carried out to assess the proportion of primary psychiatric dermatoses in the pediatric population seeking dermatological care. Materials and Methods: This was a hospital-based cross-sectional observational study done over 6 months. All consecutive children

Background: Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars. Materials and Methods: We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome. Results: Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications. Conclusions: Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome.

Introduction: Bezoars are masses of indigestible foreign material in the gastrointestinal tract, usually in the stomach. These materials could be indigestible fruits, hair, milk products, or tablets. In children, the most common type of bezoar is trichobezoar (formed from hair). Case Presentation: We describe a female patient who has been complaining about deterioration of mood, collapse without losing consciousness, scotomas, and cardiac arrhythmia for 2 years. Based on the results of thyroid hormone, resistance to thyroid hormone (RTH) was suspected. Physical examination during hospitalization revealed a palpable upper abdominal mass. Several diagnostic examinations were performed. The abdominal ultrasound showed acoustic shadowing caused by a pathological structure in the upper abdomen. Therefore, the contrast X-ray of the digestive tract revealed a deficit of contrast with an irregular shape in the stomach body and the pylorus region. Due to these results, a gastroscopy was performed, which revealed a large trichobezoar of the stomach. The trichobezoar was surgically removed without complications. Conclusion: The case presented shows that these nonspecific symptoms and laboratory test suggesting RTH require multi-path diagnostics and the cooperation of many specialists, ultimately giving a surprising diagnosis. It is crucial to interpret diagnostic examinations with regard to the patient’s physical condition. Diagnosis of trichobezoar requires a detailed search of causes to avoid another incident.

Background: Early studies identified sensory phenomena as an important facet of hair pulling and skin picking. Research in this area has grown in recent years; however, extant research on sensory abnormalities in BFRBs demonstrates limitations. The current study seeks to address gaps in the literature by examining differences in the experiences of sensory phenomena among patients with BFRBs as compared to healthy controls. Methods: Participants were 106 individuals, including 72 with BFRBs (32 hair pulling disorder [HPD], 31 skin picking disorder [SPD], 9 HPD with SPD) and 34 healthy controls, aged 11–65 years. All participants were assessed for psychiatric diagnosis via clinician-rated interviews and rated global hair pulling and skin picking severity. Participants also rated sensory phenomena using the Sensory Gating Inventory and Adolescent/Adult Sensory Profile. Results: Results revealed that participants with BFRBs exhibited significantly (or trends towards significantly) higher scores across most sensory domains (i.e., Over-inclusion, Distractibility, Stress-Fatigue Vulnerability, Low Registration, Sensation Avoidance, and Sensation Sensitivity) than healthy controls. There were no significant differences between discrete BFRB groups across any sensory experience. There were positive, moderate associations between a clinician-rated measure of skin picking-related global severity and most sensory experiences. Conclusions: These findings suggest that sensory dysregulation does separate those with BFRBs from healthy controls. Implications for future research and treatment are discussed. [ABSTRACT FROM AUTHOR]

Background: Body-focused repetitive behaviors (BFRBs) are common but under-recognized mental disorders. The present study aimed to examine the efficacy of a video presentation of self-help techniques for BFRBs compared to a web-based intervention containing psychoeducation and comprehensive self-help treatment information on BFRBs to reduce symptomatology as well as the same videos as in the first condition. Methods: A total of 217 participants with BFRBs were randomly assigned to (1) a video condition conveying the established self-help techniques habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) to reduce BFRBs, (2) a website condition that offered psychoeducational information and treatment material, including the videos from the first treatment condition, or (3) a waitlist control (WLC) condition. A six-week post assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale 45 (GBS-45) served as the primary outcome. Results: The self-help video condition showed greater improvement in GBS-45 subscales for nail biting in comparison to the self-help website and WLC conditions. For other BFRBs (e.g., joint cracking, trichophagia), the impairment subscale showed significant results in post hoc analyses in favor of the two treatment conditions. Subjective ratings of the techniques were satisfactory and comparable across treatment groups, with slightly higher ratings in favor of the video condition. Conclusions: The video condition showed better improvement than the control condition on nail biting and other BFRBs. Superior results in the self-help website condition compared to the WLC were shown only for the group of "other" BFRBs (i.e., not trichotillomania, nail biting, dermatillomania, lip/cheek biting). We speculate this might be because users were overwhelmed by the many different approaches described without clear guidelines for how to implement them in daily life. In light of a prior study, we assume that a manualized version of the self-help techniques is superior to the video delivery and recommend that the self-help videos should be used as a complement to a manualized version. Future research should address long-term effects of self-help interventions for BFRBs. [ABSTRACT FROM AUTHOR]