Tricotilomania: dificuldades diagnósticas e relato de dois casos

pacientes. Descricao do caso: Uma adolescente com diagnostico de tricotilomania "pura" e outra menina cujo quadro estava associado ao transtorno obsessivo-compulsivo. Embora com o tratamento, a evolucao de ambas tenha sido favoravel, houve demora significativa para estabelecer o diagnostico e encaminha-las a um servico de saude mental, com prejuizos escolares e sociais. Comentarios: A tricotilomania difere dos quadros benig- nos e transitorios de arrancar cabelos observados nos primei- ros anos de vida e ainda e subdiagnosticada. A vergonha dos sintomas observada nos portadores e o desconhecimento por parte dos profissionais de saude contribuem para essa situa - cao. O quadro pode ser grave, particularmente se acompanha- do de tricofagia. Profissionais da saude precisam identificar o transtorno precocemente e encaminhar as criancas para tratamento especializado antes das possiveis complicacoes clinicas e repercussoes psicossociais. AbstRAct Objective: To report two cases of trichotillomania, an underdiagnosed psychiatric disorder that may be associated with important social and clinical problems. The clinical features will be highlighted considering the implications of early diagnosis on patients' outcome. Case description: An adolescent with isolated trichotil- lomania and another girl whose symptoms were associ- ated with obsessive-compulsive disorder are described. Although both patients presented a favorable outcome with treatment, there was a significant delay in establish - ing the diagnosis and in referring them to a mental health service, leading to negative impact in educational and social domains. Comments: Trichotillomania differs from the benign and transitory hair pulling habits observed in the first years of life, and it is still underdiagnosed. The embarrassment related the patients' symptoms and the lack of knowledge of health professionals contribute to this situation. The condition may be severe, particularly if associated with trichophagia. Health care professionals need to identify the disorder early and refer these children to specialized treatment before clinical complications and psychosocial problems occur.