Trichotillomania and the mourning process: a case report and review of the psychodynamics.

Résumé

We present our theory of trichotillomania (hair pulling) as a manic phenomenon, complementary to its classic comprehension as a mourning response. Under certain conditions, separation or threat of separation can generate sadness or grief, while in pathological cases, when the loss is experienced as unbearable, the response might be depressive or manic. We suggest that in trichotillomania (TR), like in mania, manic defenses are used to cope with separation. We believe hair pulling is an expression of primary magical thinking, offering the subject an illusion of control and victory over the object. A representative case of a young woman suffering from bipolar disorder with TR is described. Based on our case analysis, we argue that TR may not necessarily be a variant of OCD, but rather classified among the affective disorders.