Trichotillomania and comorbidity in adolescents: two case reports

Trichotillomania (TTM) is a relatively rare disorder. In recent editions of the Diagnostic and Statistical Manual of Mental Disorders(DSM-V, 2013), TTM is classifi ed in the group including obsessive-compulsive and related disorders. TTM also has somecharacteristics of the disorders of impulses and habits. Initially, TTM symptoms usually occur during adolescence. The clinicalpicture in children and adolescents is often complicated by the presence of comorbidity. In children and adolescents, the mostcommon comorbidity is in the domain of aff ect, specifi cally depression and anxiety. Rarely described comorbidities are tics, hyperkineticdisorder, obsessive-compulsive disorder, various forms of regressive behavior, and some others. In the two casesreported, recognizing TTM was impeded. Specifi cally, children and adolescents reluctantly acknowledge TTM, so recognizingand further treatment was in many ways multidisciplinary and depended on the comorbidity. In the fi rst case, the etiopathogenesisis mostly emotional. In the second case, the associated disorder is from the group of neurodevelopmental disorders.The choice of psychotherapeutic techniques and broader approach to the treatment entirely depended on the comorbidityand also required cooperation of experts from other areas of pediatric medicine. We believe that research should persistentlybe focused on discovering direct and other relationships of TTM and comorbidity in order to allow for the most appropriateand eff ective recognizing and treatment of this disorder.

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