Double Jeopardy - A Case Of Trichotillomania And Intellectual Disability

ABSTRACT

Objective: The commonest age of onset for Trichotillomania is between 9 to 13 years of age and at times triggered by Depression and stress. According to literature, the best treatment is a combination of clomipramine and Cognitive Behaviour Therapy. The objective of this index case is to present a patient with an older age of onset, and with co-morbid intellectual disability and the challenges faced during treatment because of the comorbidity. Methods: A case of Intellectual disability who presented with Trichotillomania, and Trichophagia was chosen and followed up for a period of three years. Results: The hair-pulling behaviour in the index case was due to a strong urge, which was relieved by the behaviour and was not secondary to other symptoms. The course of trichotillomania was independent of the course of aggression as improvement in aggressive symptoms was not accompanied by improvement in hair-pulling behaviour, which responded to administration of Imipramine, though it did not improve with clomipramine and citalopram, which are the medications of choice. Conclusion: The index case suggests customizing treatment according to individual suitability, and choosing a medication that the patient is comfortable with, is important. It also suggests true comorbidity between Intellectual Disability and Trichotillomania, as the symptom of trichotillomania was not secondary to the aggressive behaviour exhibited by the patient.