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    Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome.
    Eur Child Adolesc Psychiatry 2017 Nov 2. Epub 2017 Nov 2.
    Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6254, Boston, MA, 02114, USA.
    Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Read More

    Syphilitic alopecia: uncommon trichoscopic findings.
    Dermatol Pract Concept 2017 Jul 31;7(3):55-59. Epub 2017 Jul 31.
    Dermatology Unit, Department of Medical, Surgical and Neuro Sciences, University of Siena, Siena, Italy.
    Syphilitic alopecia (SA) is considered an uncommon manifestation of secondary syphilis. SA can present in a diffuse form, resembling telogen effluvium, or in a moth-eaten form that mimics a variety of conditions (i.e. Read More

    Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease.
    J Dermatolog Treat 2017 Nov 5:1-10. Epub 2017 Nov 5.
    c Psychiatry and Neurology Department , Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA.
    Approximately half of all patients presenting to dermatologists exhibit signs and symptoms of psychiatric conditions that are either primary or secondary to cutaneous disease. Because patients typically resist psychiatric consult, dermatologists often are on the front line in evaluating and treating these patients. Accordingly, distinguishing the specific underlying or resulting psychiatric condition is essential for effective treatment. Read More

    Endoscopic shaving of hair in a gastric bypass patient with a large bezoar.
    BMJ Case Rep 2017 Oct 9;2017. Epub 2017 Oct 9.
    Department of Gastroenterology, Island Gastroenterology Consultants, West Islip, New York, USA.
    Trichotillomania can be associated with the formation of trichobezoars (hair ball) usually located in the stomach. Trichobezoars may lead to complications including bowel obstruction, and perforation. Patients with a history of diabetes, certain psychiatric disorders, prior gastric surgery and poor mastication ability are at an increased risk of developing bezoars. Read More

    Clarifying the Relationship between Trichotillomania and Anxiety.
    J Obsessive Compuls Relat Disord 2017 Apr 4;13:30-34. Epub 2017 Mar 4.
    Department of Psychology, Marquette University, Cramer Hall, 317, 604 N. 16th St., Milwaukee, WI, 53233, USA.
    Although research has consistently linked unidimensional anxiety with Trichotillomania (TTM) severity, the relationships between TTM severity and anxiety dimensions (i.e., cognitive and somatic anxiety) are unknown. Read More

    Trichotillomania: a good response to treatment with N-acetylcysteine.
    An Bras Dermatol 2017 Jul-Aug;92(4):537-539
    Trichology Outpatient Clinic, Department of Cosmetology, Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil.
    Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one's hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. Read More

    Corticostriatal circuit defects in Hoxb8 mutant mice.
    Mol Psychiatry 2017 Sep 26. Epub 2017 Sep 26.
    Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT, USA.
    Hoxb8 mutant mice exhibit compulsive grooming and hair removal dysfunction similar to humans with the obsessive-compulsive disorder (OCD)-spectrum disorder, trichotillomania. As, in the mouse brain, the only detectable cells that label with Hoxb8 cell lineage appear to be microglia, we suggested that defective microglia cause the neuropsychiatric disorder. Does the Hoxb8 mutation in microglia lead to neural circuit dysfunctions? We demonstrate that Hoxb8 mutants contain corticostriatal circuit defects. Read More

    Hair Loss: Common Causes and Treatment.
    Am Fam Physician 2017 Sep;96(6):371-378
    Washington Health Systems Family Medicine Residency, Washington, PA, USA.
    Hair loss is often distressing and can have a significant effect on the patient's quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist. Read More

    Trichobezoar with and without Rapunzel syndrome in paediatric population: A case series from a tertiary care centre of Northern India.
    Int J Surg Case Rep 2017 8;40:23-26. Epub 2017 Sep 8.
    Deptt. of Pediatrics, PGIMS, Rohtak, Haryana, India. Electronic address:
    Introduction: Trichobezoars are concretions formed by accumulation of hair in stomach. Usually, trichobezoar is confined to the stomach, but rarely it may extend from the stomach to the small intestine and even colon. This is an unusual form called Rapunzel syndrome. Read More

    A Preliminary Investigation of Metacognitive Therapy and Habit Reversal as a Treatment for Trichotillomania.
    Behav Cogn Psychother 2017 Sep 14:1-20. Epub 2017 Sep 14.
    Hakim Sabzevari University,Sabzevar,Iran.
    Background: Not all patients suffering from trichotillomania (TTM) recover completely using CBT and of those that do, only a few maintain their recovery over time.

    Aims: The purpose of the present study was to investigate the effectiveness of metacognitive methods combined with habit reversal (MCT/HRT) in trichotillomania with a relatively long-term follow-up.

    Method: A case series (n = 8) and a randomized wait-list controlled trial (n = 34) design were conducted in this study. Read More

    Pathological grooming: Evidence for a single factor behind trichotillomania, skin picking and nail biting.
    PLoS One 2017 13;12(9):e0183806. Epub 2017 Sep 13.
    Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
    Although trichotillomania (TTM), skin picking (SP), and nail biting (NB) have been receiving growing scientific attention, the question as to whether these disorders can be regarded as separate entities or they are different manifestations of the same underlying tendency is unclear. Data were collected online in a community survey, yielding a sample of 2705 participants (66% women, mean age: 29.1, SD: 8. Read More

    Naltrexone in the Treatment of Broadly Defined Behavioral Addictions: A Review and Meta-Analysis of Randomized Controlled Trials.
    Eur Addict Res 2017 7;23(4):204-210. Epub 2017 Sep 7.
    Unité de Psychiatrie d'Urgence, de Liaison et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France.
    Introduction: Broadly defined behavioral addiction is a conceptual framework including behaviors characterized by loss of control and continuation despite significant negative consequences. Broadly defined behavioral addictions share many similarities with substance use disorders. As naltrexone is one of the most studied treatment for substance use disorders, we conducted a meta-analysis of randomized placebo-controlled trials (RCT) assessing the effectiveness of naltrexone in the treatment of broadly defined behavioral addictions. Read More

    RAPUNZEL SYNDROME - AFRICAN VARIATIONS ON A EUROPEAN FAIRYTALE.
    S Afr J Surg 2017 Sep;55(3):68
    University of Cape Town, and Groote Schuur Hospital.
    Background: Trichobezoars are intraluminal accretions of ingested hair. Rapunzel syndrome is a rare and extreme presentation with extension down through into the small intestine. Most frequently reported in children and psychiatric patients, we report on an African series of five patients. Read More

    Gastric Trichobezoars in Children: Surgical Overview.
    Int J Trichology 2017 Apr-Jun;9(2):50-53
    Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
    Background: Development of trichobezoars in children is primarily a psychiatric issue more than a pediatric surgical ailment. A definite history of trichotillomania and trichophagia may or may not be elicited. Surgical removal is required in patients presenting with huge bezoars. Read More

    Systematic Review of Published Primary Studies of Neuropsychology and Neuroimaging in Trichotillomania.
    J Int Neuropsychol Soc 2017 Aug 24:1-18. Epub 2017 Aug 24.
    1Department of Psychology and Centre for Mental Health,Swinburne University of Technology,Hawthorn,Victoria,Australia.
    Objectives: Existing models of trichotillomania (TTM; hair pulling disorder) rely heavily on a biological predisposition or biological pathogenesis of the disorder, but fail to capture the specific neuropsychological mechanisms involved. The present systematic review aims to scope existing neuropsychological studies of TTM to explore gaps in current models.

    Methods: A systematic literature search was conducted to detect all published primary studies using neuropsychological and neuroimaging measures in a cohort of individuals experiencing TTM. Read More

    A Practical Approach to the Diagnosis and Management of Hair Loss in Children and Adolescents.
    Front Med (Lausanne) 2017 24;4:112. Epub 2017 Jul 24.
    Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States.
    Hair loss or alopecia is a common and distressing clinical complaint in the primary care setting and can arise from heterogeneous etiologies. In the pediatric population, hair loss often presents with patterns that are different from that of their adult counterparts. Given the psychosocial complications that may arise from pediatric alopecia, prompt diagnosis and management is particularly important. Read More

    Trichotillomania in celiac disease patient refractory to iron replacement.
    Int J Adolesc Med Health 2017 Aug 5. Epub 2017 Aug 5.
    .
    Trichotillomania is characterized by recurring hair pulling behavior and repeated attempts to decrease or stop the behavior. This behavior can cause a trichobezoar, which is a mass of hair found in the stomach. Patients with diagnosed celiac disease may have an urge to swallow their hair due to iron or folat deficiency, which is called pica. Read More

    Excoriation (skin-picking) disorder: a systematic review of treatment options.
    Neuropsychiatr Dis Treat 2017 14;13:1867-1872. Epub 2017 Jul 14.
    SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
    Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive-compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Read More

    [Rapunzel syndrome as a cause of obstruction and intestinal perforation].
    Acta Gastroenterol Latinoam 2016 06;46(2):114-7
    The following is a case report involving a 16 year old female with trichotillomania as an antecedent. This patient presented to the Emergency Room with a chief complaint of early satiety and persistent abdominal pain for the past 3 months. However, recently her abdominal pain has worsened and it is now complicated by nausea and vomiting. Read More

    Predictors of comorbid eating disorders and association with other obsessive-compulsive spectrum disorders in trichotillomania.
    Compr Psychiatry 2017 Oct 21;78:1-8. Epub 2017 Jun 21.
    Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. Electronic address:
    Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18-65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. Read More

    Cortical thickness abnormalities in trichotillomania: international multi-site analysis.
    Brain Imaging Behav 2017 Jun 29. Epub 2017 Jun 29.
    Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
    Trichotillomania is a prevalent but often hidden psychiatric condition, characterized by repetitive hair pulling. The aim of this study was to confirm or refute structural brain abnormalities in trichotillomania by pooling all available global data. De-identified MRI scans were pooled by contacting authors of previous studies. Read More

    Placebo response in trichotillomania.
    Int Clin Psychopharmacol 2017 Nov;32(6):350-355
    aDepartment of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, Chicago, Illinois bDepartment of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts cDepartment of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA dSchool of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen eH. Lundbeck A/S, Copenhagen fDepartment of Psychiatry, University of Cambridge gCambridge and Peterborough NHS Foundation Trust, Cambridge, UK hDepartment of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.
    Trichotillomania is a functionally impairing, often overlooked disorder with no Food and Drug Administration-approved medications indicated for its treatment. The ability of clinical trials to detect the beneficial effects of pharmacologic treatment in trichotillomania has been hampered by the high placebo response rate. Very little is known about baseline demographic and clinical characteristics that may be predictive of placebo response in such patients. Read More

    Dissociation and conversion symptoms in dermatology.
    Clin Dermatol 2017 May - Jun;35(3):267-272. Epub 2017 Jan 21.
    Department of Medicine, Faculty of Medicine, University of Toronto, Ontario, Canada.
    Dissociation and conversion (defined as the somatic component of dissociation) can play an important mediating role in the exacerbation of the stress-reactive dermatoses (eg, psoriasis, idiopathic urticaria, atopic dermatitis), dermatoses that are exacerbated by excessive scratching (eg, lichen simplex chronicus, prurigo nodularis) and koebnerization, and the self-induced dermatoses (dermatitis artefacta, acne excoriée, skin picking disorder, trichotillomania, onychotillomania/onychophagia). Dissociative symptoms often coexist with obsessive-compulsive symptoms in the more severe cases of the self-induced dermatoses. Dissociation can play an important role in cutaneous sensory disorder (eg, scalp dysesthesia syndrome, stomatodynia/glossodynia, vulvodynia/scrotodynia, medically unexplained anesthesia). Read More

    Posttraumatic stress disorder (PTSD) and the dermatology patient.
    Clin Dermatol 2017 May - Jun;35(3):260-266. Epub 2017 Jan 22.
    Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
    Dermatologic symptoms can be associated with posttraumatic stress disorder (PTSD) in several situations: (1) as features of some core PTSD symptoms, such as intrusion symptoms manifesting as cutaneous sensory flashbacks, as autonomic arousal manifesting as night sweats and idiopathic urticaria, and as dissociation manifesting as numbness and dermatitis artefacta; (2) the cutaneous psychosomatic effects of emotional and physical neglect and sexual abuse (eg, infantile eczema, cutaneous self-injury, and body-focused repetitive behaviors such as trichotillomania and skin picking disorder) and eating disorders, which can have dermatologic effects; (3) the direct effect of physical or sexual abuse or catastrophic life events (eg, earthquakes) on the skin; and (4) as a result of significant alterations in hypothalamic-pituitary-adrenal and sympatho-adrenal medullary axes, which can affect neuroendocrine and immune functions, and can lead to exacerbations of stress-reactive inflammatory dermatoses such as psoriasis, chronic urticaria, and atopic dermatitis. Elevated levels of inflammatory biomarkers and impaired epidermal barrier function have been reported in situations involving sustained psychologic stress and sleep deprivation. Some PTSD patients show hypothalamic-pituitary-adrenal axis hyporesponsiveness and higher circulating T lymphocytes, which can exacerbate immune-mediated dermatologic disorders. Read More

    "Hair in the Bladder": An Unusual Finding.
    J Endourol Case Rep 2017 1;3(1):28-30. Epub 2017 Mar 1.
    Department of Urology, ASL 2 Abruzzo, Chieti, Italy.
    Trichobezoar is a rare condition whereby a hairball is found in the human stomach or gastrointestinal tract, most frequently in young women, mainly in association with a psychiatric disorder. Trichobezoar cases have also been reported in the bladder and represent a rare complication of foreign bodies, called "hair nidus or hair ball," in patients with chronic catheter. Approximately 10% to 15% of patients on long-term urethral catheter or clean intermittent self-catheterization develop urinary tract stones. Read More

    Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention.
    Neuropsychiatr Dis Treat 2017 21;13:1153-1162. Epub 2017 Apr 21.
    Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
    Background: Many patients suffering from trichotillomania (TTM) have never undergone treatment. Without treatment, TTM often presents with a chronic course. Characteristics of TTM individuals who have never been treated (untreated) remain largely unknown. Read More

    Attentiveness of Dermatologists in the Middle East to Psychocutaneous Medicine.
    Prim Care Companion CNS Disord 2017 Apr 27;19(2). Epub 2017 Apr 27.
    Department of Psychiatry and Behavioral Sciences, College of Medicine, Central Michigan University, Saginaw, Michigan, USA.
    Objective: Patients with skin diseases often have psychological problems and complications that require assessment and treatment. The main objective of this study was to explore attentiveness of dermatologists to psychiatric symptoms in their patients.

    Methods: A previously validated online questionnaire was used to explore the attitude and experience of dermatologists practicing in the Middle East toward the assessment of the psychiatric needs of their patients. Read More

    Trichobezoar presenting as a gastric outlet obstruction: A case report.
    Int J Surg Case Rep 2017 16;34:123-125. Epub 2017 Mar 16.
    Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, United States.
    Introduction: Rapunzel syndrome is a rare intestinal condition that starts with the ingestion of a trichobezoar. The condition is predominately found in females and can be associated with trichotillomania, or the compulsive urge to pull one's own hair out. There are less than 40 cases described in the literature with the prevention of recurrence aimed at psychological treatment. Read More

    Trichotillomania and its clinical relationship to depression and anxiety.
    Int J Psychiatry Clin Pract 2017 Nov 21;21(4):302-306. Epub 2017 Apr 21.
    e Department of Psychiatry , Massachusetts General Hospital/Harvard Medical School , Boston , MA , USA.
    Objective: Trichotillomania (TTM) is associated with high rates of co-occurring depression and anxiety disorders. What the co-occurrence of TTM, depression or anxiety disorders means clinically and cognitively, however, has garnered little research attention.

    Methods: About 530 adults with TTM were examined on a variety of clinical measures including symptom severity, psychosocial measures of functioning, psychiatric comorbidity and neurocognitive testing assessing motor inhibition and cognitive flexibility. Read More

    Preventing, treating, and predicting barbering: A fundamental role for biomarkers of oxidative stress in a mouse model of Trichotillomania.
    PLoS One 2017 20;12(4):e0175222. Epub 2017 Apr 20.
    Department of Comparative Medicine, Stanford University, Stanford, California, United States of America.
    Barbering, where a "barber" mouse plucks hair from its cagemates or itself, is both a spontaneously occurring abnormal behavior in mice and a well validated model of Trichotillomania (TTM). N-Acetylcysteine, (NAC) a cysteine derived food additive, is remarkably effective in treating TTM patients, but its mechanism of action is unknown. Reactive Oxygen Species (ROS), also known as free radicals, form as a natural byproduct of the normal metabolism of oxygen. Read More

    Psychocutaneous disease: Clinical perspectives.
    J Am Acad Dermatol 2017 May;76(5):779-791
    Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts. Electronic address:
    Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. Read More

    Trichotillomania: a case report with clinical and dermatoscopic differential diagnosis with alopecia areata.
    An Bras Dermatol 2017 Jan-Feb;92(1):118-120
    Department of Dermatology of the Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil.
    Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Read More

    [Psychosomatic disorders of the scalp].
    Hautarzt 2017 Jun;68(6):445-448
    Vivantes Netzwerk für Gesundheit GmbH, Klinik für Dermatologie und Allergologie, Immunonkologisches Zentrum, Schwerpunkt Männermedizin, Vivantes Klinikum Spandau, Akademisches Lehrkrankenhaus, Charité - Universitätsmedizin Berlin, Neue Bergstr. 6, 13585, Berlin, Deutschland.
    Psychosomatic disorders of the scalp have some special characteristics due to the visibility, possible stigmatization, and amount/patterns of hair. Of practical relevance is trichotillomania, which is now classified as an obsessive-compulsive disorder (OCD). Patients who are obsessed with normal physiological hair loss represent a further psychodermatological challenge. Read More

    Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update.
    Adv Mind Body Med 2017 Winter;31(1):10-13
    Context • Excoriation (skin picking) disorder is characterized by the need or urge to pick, scratch, pinch, touch, rub, scrub, squeeze, bite, or dig the skin, and it can be a perplexing condition for the inexperienced physician. Treatments include pharmacotherapy, psychotherapy, and alternative therapies. Alternative therapies for excoriation disorder and other body-focused repetitive behaviors include yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine, among others. Read More

    Pulling your hair out in geriatric psychiatry: a case report.
    Int Psychogeriatr 2017 Apr 1;29(4):691-694. Epub 2017 Feb 1.
    Department of Psychiatry & Behavioral Neuroscience,University of Chicago,Pritzker School of Medicine,Chicago,Illinois,USA.
    Trichotillomania is a relatively understudied psychiatric disorder. Even less is known about this disorder in the elderly. We describe an unusual case of an elderly woman presenting for the first time with trichotillomania at age 70 and highlight the treatment complexities we encountered. Read More

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