Purple nostrils? Talk to your doctor about imipramine

Case report

The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder

L. F. Fontenelle11The Anxiety and Depression Research Program and ,
M. V. Mendlowicz22The Ethics Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil,
Dr Leonardo F. Fontenelle, Rua Lopes Trovão 88, apt. 1501, Bloco A, Icaraí, Niterói, RJ, CEP 24220 071, Brazil
Fontenelle LF, Mendlowicz MV, Mussi TC, Marques C, Versiani M. The man with the purple nostrils: a case of rhinotrichotillomania secondary to body dysmorphic disorder.
Acta Psychiatr Scand 2002: 106: 464–466. © Blackwell Munksgaard 2002.

Abstract

Objective: To describe a different type of self-injurious behavior that may be secondary to body dysmorphic disorder (BDD).

Method: 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.

Conclusion: 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.

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