Asian Journal of Medical Principles and Clinical Practice

Introduction: Trichotillomania, often considered an impulse control disorder, can sometimes conceal a more severe underlying psychiatric condition. We report the case of an adolescent initially hospitalized for a trichobezoar, revealing a progressive psychotic disorder.

Clinical Case: Ms. A, 16 years old, with no significant personal or family medical or psychiatric history, was referred to our department following surgical intervention for a trichobezoar. The psychiatric evaluation revealed chronic psychotic symptoms. The onset dated back approximately four months. Physical and paraclinical investigations (brain imaging, neurological examination, biological tests) were unremarkable.

Discussion: The differential diagnosis initially ruled out organic, endocrine, and toxic causes. From a psychiatric standpoint, several hypotheses were considered: persistent delusional disorder, bipolar disorder with psychotic features, schizoaffective disorder, and paranoid schizophrenia. The clinical evolution, symptomatology, and impaired social functioning pointed toward early-onset paranoid schizophrenia, without excluding a schizoaffective disorder, comorbid with trichotillomania.

Conclusion: This case highlights the importance of thorough psychiatric assessment in adolescents presenting with behavioral disorders, even when appearing isolated, as in trichotillomania. Early detection of a psychotic disorder allows for appropriate management and improves functional prognosis.