Trichtillomaniac, maniac on the floor!

NewFNP has few compulsions. Yes, she likes to keep her eyebrows groomed. True, she flosses regularly. OK sure, she wishes that she was more of a compulsive exerciser, but who amongst us could resist the lure of Harold & Kumar Go To White Castle arriving via Netflix? NewFNP is not made of steel!

What newFNP does not do is pull her own hair out. Figuratively speaking, sure, during a tough clinic day. But literally? Friends, newFNP quite frankly spends too much on highlights to just toss these tresses aside!

NewFNP would have never suspected her first trichotillomaniac this week. Please bear in mind that it is Tuesday and that newFNP works in family practice, not psych. Anyway, this woman only pulls out her eyelashes. Holy crap, that has got to hurt! NewFNP's patient was less concerned with the pain, however, than she was with the mounting costs of false eyelashes. She felt despair because, as she said, her natural lashes were much more lush than the falsies. She felt embarrassed that she could not stop pulling them out. She never even mentioned pain, although newFNP is wincing at the thought of pulling out her own eyelashes. Fuck. No. NewFNP grimaces when one lash gets a little cattywompus and has to be realigned.

The second trichotillomaniac has been a patient in newFNP's practice for as long as newFNP has been there. Today, she told newFNP that she has been pulling out the hair on her scalp for years and has now begun to yank out her armpit hair. Now, newFNP has waxed her own axillae and knows that experience to be somewhat unpleasant. But to take each hair out individually? No, no sir. No can do.

This patient has beautiful braids and has them styled in a fashion which successfully hides her compulsion. But move them aside and hello patchy alopecia!

Now, newFNP's family practice curriculum did not really cover trichotillomania. NewFNP only really knows about it because there was a random treatment center in the town where she completed her undergrad education and she felt compelled to learn what in the hell the place treated! What newFNP didn't know then is that some trichotillomaniacs eat their pulled hair. These folks can develop trichobezoars, or hair casts, in their stomachs and intestines.

Go ahead and put that on your differential for abdominal pain.