Trichotillomania: symptom or syndrome? A need for revision.

A 40-year-old religious Hindu male presented with his fourth episode of mania along with repetitive plucking of hair. This unusual behaviour was explained by him as a way to 'attain divinity by discarding the impure demoniac hair'. He had not shown this symptom in the previous episodes. With treatment of the mood disorder the hair plucking also disappeared. Hair removal has an important religious-cultural meaning in eastern India. Possible implication of the symptom is discussed. A case is made for reporting hair plucking as a symptom rather than a syndrome and it may at times represent a culture-specific symptom.