Trichotillomania is more common than is generally appreciated, especially in children. At the Mayo Clinic, we saw 145 patients in a ten-year period (1968-1977), and we have observed approximately 15 to 20 such patients per year since that time. Trichotillomania can be a mild or major cosmetic impairment and can be a minor neurotic trait or a sign of serious psychiatric disorder. Although the clinical presentation is characteristic, it can be confused with many different types of alopecia but particularly alopecia areata. Punch biopsy of the affected scalp may be very useful in confirming the clinical diagnosis of trichotillomania, particularly if catagen hairs, melanin casts, and signs of follicular tear or avulsion are present. Trichophagy and trichobezoars are rare associated disorders that should be sought. A common sense approach with a kind and honest explanation to the patient or the parents may be sufficient to terminate the hair-pulling. It is the responsibility of the physician to determine whether psychiatric consultation is desirable in the assessment and treatment of associated psychiatric disorders. Patients in whom the trichotillomania is resistant to simple reinforcement and explanation should have psychiatric consultation. Intensive psychotherapy may be worthwhile in selected patients.
拔毛癖比人们普遍认为的更为常见，尤其是在儿童中。在梅奥诊所，我们在十年期间（1968 - 1977年）接诊了145例患者，自那时起，我们每年观察到约15至20例此类患者。拔毛癖可能是轻度或重度的外貌损伤，可能是轻微的神经特质，也可能是严重精神疾病的迹象。尽管临床表现具有特征性，但它可能与许多不同类型的脱发相混淆，尤其是斑秃。对受影响头皮进行钻孔活检在确诊拔毛癖的临床诊断中可能非常有用，特别是如果存在退行期毛发、黑素栓以及毛囊撕裂或脱失的迹象。食毛癖和毛粪石是罕见的相关病症，应予以排查。对患者或其父母采取一种常识性的方法并给予友善和诚实的解释，可能足以终止拔毛行为。在评估和治疗相关精神疾病时，确定是否需要精神科会诊是医生的责任。对简单强化和解释治疗有抵抗的拔毛癖患者应进行精神科会诊。在某些选定的患者中，强化心理治疗可能是值得的。
