Trichotillomania is a psychiatric disorder characterized by an urge to pull out hair from the scalp or other parts of the body (Impulse Control Disorder) relatively uncommon in children.

The following two clinical vignette highlight varying presentation of trichotillomania in children from two differing age groups (>6 yrs and <12 yrs)

To showcase 2 cases of trichotillomania with differing co-morbidities.

ICD 10 (WHO) was the primary diagnostic tool used here. MGH Hair Pulling Scale was used for rating the severity of Trichotillomania. As both patients had suspected mental sub normality, WISC was used for IQ assessment.

Case 1: Trichotillomania with OCD and ?Secondary depression with MR

14 year old female, presented with compulsive eyebrow pulling for 1 year. For last 6 months showing OCD and depressive symptoms. She scored 32 on YBOCS with main obsession – excessive concerns with germs and main compulsions - excessive or ritualized hygiene. On MGH hair Pulling scale she scored 21. Her IQ score was 65, suggesting Mild Intellectual Disability.

Case 2: Trichotillomania with Pica and MR

5 year old female, presented with compulsive hair pulling and ingesting it (Trichophagia) for 18 months. Also eating non edible things like soil and paper (Pica). No major physical illness found. On MGH Hair Pulling Scale, she scored 17. X-ray of GIT showed no Trichobezoar (hair ball). Her IQ was 60, (Mild Intellectual Disability).

The study illustrates how trichotillomania can be a part of a more complex psychiatric presentation with co-morbidities