The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder.
OBJECTIVE
To describe a different type of self-injurious behavior that may be secondary to body dysmorphic disorder (BDD).


METHODS
Single case report.


RESULTS
We reported a case of an individual who have developed the self-destructive habit of pulling and severely scraping hairs and debris out of the mucous membrane of his nasal cavities. We have proposed the term rhinotrichotillomania to emphasize the phenomenological overlapping between trichotillomania (TTM) and rhinotillexomania (RTM) exhibited by this case. The main motivation behind the patient's actions was a distressing preoccupation with an imaginary defect in his appearance, which constitutes the core characteristic of BDD. The patient was successfully treated with imipramine.


CONCLUSIONS
The case suggests that certain features of TTM, RTM, and BDD may overlap and produce serious clinical consequences. Patients with this condition may benefit from a trial of tricyclics when other effective medications, such as serotonin reuptake inhibitors, are not available for use.
Fontenelle
L F
LF
The Anxiety and Depression Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil. lfontenelle@bigfoot.com
Mendlowicz
M V
MV
Mussi
T C
TC
Marques
C
C
Versiani
M
M
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001828:Body Image; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000523:psychology; D006801:Humans; D007099:Imipramine / Q000627:therapeutic use; D008297:Male; D009666:Nose; D013001:Somatoform Disorders / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D009626:Terminology as Topic; D016896:Treatment Outcome; D014256:Trichotillomania / Q000188:drug therapy / Q000523:psychology*
D018759:Adrenergic Uptake Inhibitors; D000929:Antidepressive Agents, Tricyclic; D007099:Imipramine