Trichotillomania (TTM) is an impulse-control disorder characterised by recurrent hair pulling, which can result in noticeable hair loss. Prevalence data suggest that trichotillomania affects approximately 0.6–1%1 2 of the population, especially women, and is often associated with obsessive–compulsive and depressive disorder. Although trichotillomania causes clinical significant distress or impairment and various treatment options are reported, this disturbance is generally treatment-resistant and relapse is common.

A 19-year old girl was referred to our psychiatric hospital due to hair pulling of the scalp and eyebrows, which resulted in extensive hair loss of these areas. She reported having this behaviour since the age of 13 years, and she described an irresistible urge to pull out hair and the pleasure derived when achieving that. For the last 6 months she refused to attend her student course and avoided social contact because of her appearance concerns.

Her scores on the individual items of the Massachusetts General Hospital (MGH) Hairpulling Scale score were 3, 2, 2, 2, 2, 2, and 1, respectively. Her Beck Depression Inventory revealed no depression (score 10); her State-Trait Anxiety Inventory (STAI) showed a mild level of anxiety as a …