Hair-Pulling: A Case Study of Suzanne's Long-Standing Struggles

Presenting Problem: Patient presented with a long-standing history of pulling her hair. She reports that she would get nervous and tense if she did not do it. She would get an uncomfortable, tight feeling in her stomach and was worried that something terrible would happen. Pulling out her hair would relieve this feeling, and she would breathe easily. Suzanne states that she has repeatedly tried to resist the urge to pull her hair but has failed. Upon discovering a bald area on her temple, Suzanne says that she tried putting on individual hairstyles that would cover the bald on her head. During the winter break, she was confronted by her mother, had a lengthy discussion with her and Suzanne resolved to go into therapy. She states that she went back to college and the act of pulling her hair continued. The patient says that her hair looked so bad that she wasn't even trying to date. It was not until two years had passed that Suzanne voluntarily sought therapy.

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Medical History: No significant history reported.

History of Mental Illness: Patient states that at seventh grade, she used to play with her hair a lot and pull on it, and the more nervous she became, the tighter she pulled. She had this pervasive idea that her eyelashes and eyes were not only irritating but also had some dirt caught and stuck between the lashes. She felt that the inadequate eyelashes needed to be pulled out. She looked forward to the pain of pulling and achieved gratification and pleasure once the eyelash was out. She reports that she was unable to stop, but upon confrontation by her parents, she was able to stay out of embarrassment. She was, then, able to cope with her stresses in another way.

Stressors: Patient reports a strained relationship with her parents. She states that she feels her parents are challenging; they thought that she didn't do well enough. Break up with her first boyfriend, Jon (about two years ago).

Developmental History: No developmental delays reported. She has always hated school and still really nervous about things. She states that she didn't get along that well with most people; she just got too shy around them, and relationships with boys never seemed to go anywhere. Suzanne's mother reports that her daughter wasn't involved in any extracurricular activities

Safety Assessment: Patient not in any capacity to put herself or others at risk.

Appearance/behaviour: Patient is well kept, and rapport was quickly established. There is an area of complete alopecia at the temporal region of her head. She was, however, cooperative and answered questions spontaneously. The patient noted to pull her hair continuously. No other mannerisms noted.

Thought Processes: Patient is coherent. She denies any delusions or paranoia. She has good judgment and insight.

Mood/ Affect: Nervous and anxious. Affect is mood congruent- Patient looks uneasy and keeps reaching for her hair

Intellectual Functioning: Normal

Orientation: Patient-oriented in time, place and person

Final Diagnoses: Trichotillomania