A clinical study of seven cases of trichotillomania in Singapore.

The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a descriptive, retrospective study of all cases of trichotillomania presenting to the clinic between January 1996 and January 1998. There were 7 cases seen in a 2-year period which is less than 1% of new cases seen at the clinic. The female to male ratio was 1.33:1 with a mean age of 9.3 years. All cases met the DSM-IV criteria for trichotillomania. All 6 pulled their hair in tufts with 1 who was almost hairless. Associated problems included tics, nail-biting, anxiety and shortness of temper. Treatments included behavioural treatment, stress management, parental education and counselling as well as medications. Two improved and were discharged, with 3 still undergoing treatment and 2 defaulted follow-up. The 7 cases seen in Singapore are similar in clinical features to cases found overseas. A behavioural approach with reduction of environmental stress is most effective. Drugs were less effective. More systematic studies need to be done.