The psychodynamic significance of trichotillomania: a case study

In this paper we present a case of trichotillomania which lasted 33 years, starting with the patient's menarche at 12 years old, and lasting until her first and only pregnancy at 45 years old. We explore the psychodynamic meaning of the hair pulling, both in light of the problems related to introjective and projective processes which, in the kleinian view, gives structure to the internal world and, according to Margaret Mahler, individuation-separation theory. The hypotheses on the significance of this symptom are discovered in part in light of the material which emerged from the patient's intermittent participation in group psychotherapy for nearly five years prior to her pregnancy. Her pregnancy represents the transformational process of this symptom. Her feelings of desperation and anguish, and the rather dramatic expression of them, accompanied by constant suicidal ideas, reveal other conflicts in her primary relationships. The contact with these relational issues is accompanied by a progressive resolution of the trichotillomania. This also comes through in the significantly symbolic shift from the pulling of her own hair to the pulling of the hair from her wig.