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CLINICAL REVIEW: A Saraswat Child abuse and trichotillomania BMJ 2005; 330: 83-84 [Full text]

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Child Abuse and Trichotillomania - Is the Latter Diagnosis Warranted?

Max Wiznitzer   (7 January 2005)

The diagnosis should be "Suspected Trichotillomania"

Rajan TD   (10 January 2005)

Not a case of Trichotillomania

G.K. VANKAR   (17 January 2005)

Serial Munchausen syndrome by proxy presenting as traumatic alopecia

Salih Hamad Aljabre   (9 July 2005)

Child Abuse and Trichotillomania - Is the Latter Diagnosis Warranted? 7 January 2005
Max Wiznitzer, Child Neurologist Rainbow Babies & Childrens Hospital, Cleveland, Ohio USA 44106 Send response to journal: Re: Child Abuse and Trichotillomania - Is the Latter Diagnosis Warranted?	Dr. Saraswat's article is very interesting. He is to be commended for identifying the abusive situation. However, I question whether the initial diagnosis of trichotillomania was supported by the available clinical information. The family denied any hairpulling by the child. This criterion is essential for the diagnosis. In my clinical experience with many children with this diagnosis, it is not a secretive behavior but readily apparent to the child's caregivers. Would it have been more appropriate to list the initial diagnosis as hair loss-etiology uncertain or suspected trichotillomania than to use a psychiatric label that did not meet defined diagnostic criteria? Competing interests: None declared
The diagnosis should be "Suspected Trichotillomania" 10 January 2005
Rajan TD, Consultant Skin & Sex Transm Diseases, Andheri 0091-22-56982747 Mumbai, India, Tel: 0091-22-56982747 Send response to journal: Re: The diagnosis should be "Suspected Trichotillomania"	In this case the case was initially suspected to be of Trichotillomania. As it was later established that the hair loss on the temporovertical scalp was the result of abuse by a teacher, the diagnosis of Trichotillomania is not valid. In order to avoid confusion the title ought to be corrected to accomodate this fact. Competing interests: None declared
Not a case of Trichotillomania 17 January 2005
G.K. VANKAR, Professor and Head, Dept. of Psychiatry,B.J.Medical College and Civil Hospital Ahmedabad 380016 India Send response to journal: Re: Not a case of Trichotillomania	It is simply a case of abuse and not of trichotillomania. Competing interests: None declared
Serial Munchausen syndrome by proxy presenting as traumatic alopecia 9 July 2005
Salih Hamad Aljabre, Associate Prof. Dermatology College of medicine, King Faisal University, Dammam, saudi Arabia Send response to journal: Re: Serial Munchausen syndrome by proxy presenting as traumatic alopecia	First of all I like to command Dr Saraswat for uncovering the abusive condition.The validity of the diagnosis, trichotillomania, is questionable because the hair loss was caused by someone else and not the patient himself. Although objections to the use of the term trichotillomania have been raised (1) it is still being employed to describe a situation where the patient pulls his or her own hair. In the case presented by Dr Saraswat a more probable diagnosis would be Munchausen syndrome by proxy. The teacher was abusing the child by pulling his scalp hair, an act that has resulted in a pediatric condition falsification and it remained to be find whether the teacher has a factitious disorder by proxy which is the second component of Munchausen syndrome by proxy. In fact this case has to be labelled as serial Munchausen syndrome by proxy presenting as alopecia because more than one student were affected. It would be beneficial to know about the result of the psychiatric evaluation of the teacher. References: (1) Aljabre SHM. Trichotillomania: a trichotillosis, a trichotillotic or a tic trichotillosis. Int J Dermatol 1993; 32:823-824. Competing interests: None declared