Tiling E
Monatsschr Kinderheilkd (1902). 1975 Feb;123(2):58-64.
As a contribution to the differential diagnosis of ambiguoug "loss of hair" we forward a report on 24 children and 2 adolescents with trichotillomania. Patients with this pathological habit tear out hair from their own head -- sometimes eyelashes or eyebrows as well -- mostly in unobserved moments. Therefore the diagnosis is frequently delayed for months or even years. Most of these patients have normal intelligence are motorically overactive, and sensitive. They suffer from a lack of selfne assurance, and an inhibition to establish initial social contacts or to give expression to their aggressive tendencies. The manipulation of their own body serves as an outlet for the inner and outer strain resulting form the pressures of a permanent conflict-situation. The calming effect, combined with the apparently highly satisfying physical experience, induced repetition and the development of a fixed habit. In early childhood the factors contributing to the emotional strain are almost always found in a conflicting mother-child relationship, very often against the background of a general deficiency in family interaction. Moreover at school level the symptom occurs most frequently as a result of pressure on the child to achieve more. Trichotillomania has to be considered in children with focal or diffuse alopecia in areas of normal scalp, where almost no hair is lost by combing or gentle pulling. The trichogram gives specific results. Diagnosis must be based on a behaviour analysis and psychodiagnosis of the child. In addition, personal interactions within the family must be investigated. The first goal of therapy is the elimination of the emediate causes through counselling the parents. The improvement of the child's ability to communicate is essential. Depending on the age of the child the approach to the treatment of the social disturbances through psychotherapy or medical pedagogy should be combined with a symptom--centered treatment through behaviour therapeutical techniques with the aim of eliminating this fixed habit.
作为对鉴别诊断不明原因“脱发”的一份贡献，我们呈上一份关于24名儿童和2名青少年患拔毛癖的报告。患有这种病态习惯的患者会揪下自己头上的头发——有时也会揪睫毛或眉毛——大多是在无人注意的时候。因此，诊断常常会延迟数月甚至数年。这些患者大多智力正常，多动且敏感。他们缺乏自信，在建立初步社交联系或表达攻击倾向方面存在抑制。对自身身体的操控成为了由长期冲突情境压力所导致的内外压力的一种宣泄方式。这种平静效果，再加上显然高度令人满足的身体体验，引发了重复行为并形成了一种固定习惯。在幼儿期，导致情绪紧张的因素几乎总是存在于冲突的母子关系中，而且往往是在家庭互动普遍不足的背景下。此外，在学校阶段，这种症状最常因对孩子要求取得更多成绩的压力而出现。对于头皮正常区域出现局部或弥漫性脱发、梳头或轻轻拉扯几乎不掉头发的儿童，必须考虑拔毛癖。毛发检查会得出特定结果。诊断必须基于对孩子的行为分析和心理诊断。此外，还必须调查家庭内部的人际互动情况。治疗的首要目标是通过向家长提供咨询来消除直接原因。提高孩子的沟通能力至关重要。根据孩子的年龄，通过心理治疗或医学教育学来处理社交障碍的方法，应与通过行为治疗技术以消除这种固定习惯为目标的以症状为中心的治疗相结合。
