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Trichotillomania (hair pulling) is a term coined by Hallopeau, a French dermatologist around the turn of the century, to describe the “irresistible urge” of certain patients to pull out their hair. This symptom may be accompanied by trichophegy (hair eating). Since that time it has been regarded as of psychogenic origin but surprisingly has received scant attention in the psychiatric literature. Articles by Greenberg and Sarner (1965) and by Mannino and Delgado (1969) summarize the few references to trichotillomania.
The main focus of the literature has been on the psychopathological characteristics and etiology of trichotillomania. Typically, the condition is described in psychoanalytic or psychodynamic terms. Berg (1936) suggested that the hair pulling reflected a sexual conflict. Barahal (1940), noting the symbolic importance of hair in myth and customs (i.e. symbol of strength, beauty, mourning, and castration), essentially agreed with Berg and saw it as a manifestation of sexual maladjustment. Zaidens (1951) differentiated between the pulling out of scalp hair from that of pulling eyebrows, eyelashes, or pubic hair. He considered the latter a mild neurotic symptom used to release unsatisfied sexual tension (a masturbatory substitute) and the former, a more serious affliction, as an attempt to escape from unbearable sexual situation (e.g. marriage). Sperling (1954), in discussing a preoccupation with hair in general not specifically in reference to hair pulling, stated that hair is a symbol for unconscious bisexual conflicts; in some instances, cutting off, pulling out or losing the hair, expresses the giving up of the feminine part of the self. Masserman (1955), referring to trichotillomania as a compulsive act of the ritualistic