Giada: “la trappola dell’indegnità”, un caso di Tricotillomania in comorbilità con Disturbo ossessivo-compulsivo e Disturbo di personalità borderline

Serena Di Benedetto, Andrea Gragnani* (2021): Giada: "la trappola dell'indegnità", un caso di Tricotillomania in comorbidità con Disturbo ossessivo-compulsivo e Disturbi di personalità borderline. In: Quaderni di Psicoterapia Cognitiva, (49), 2021, ISSN: 1127-6347.


This article describes the clinical case of Giada, a 19-year-old female with a borderline personality characterized by a pervasive emotional dysregulation. Trichotillomania and obsessive-compulsive disorder, two disorders belonging to the obsessive spectrum, represent dysfunctional attempts to manage the sense of unworthiness, combined with a deep self-repulsion and the deontological guilt for irreparably worsening one’s body.
This in turn increases the risk of one’s imperfection being discovered and hence refused, abandoned by others. The repeat behaviours focused on one’s body such as hair ripping in the pubic region and legs are on one hand premeditated and ritualized, when activated by the feeling of self-repulion and the need to feel good enough, and on the other hand are an impulsive reaction to an emotional dysregulation, such as attempts to manage painful emotional and mental statuses. The patient also shows a history of anxiety and obsessive behavious such as compulsive washing, intrusive throughs, and feelings of “not just right experience” (NJRE).
The therapeutic path, within which the interventions based on Schema Therapy have played a central role, has combined standard cognitive therapy techniques with third generation techniques (Act, DBT, Mindfullness), balancing radical acceptance with a push for change. The therapeutic relationship has proven an important tool to contain emotional experiences linked to self-unworthiness.