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Trichotillomania became a daily routine in the patient's life during the past five years. Diagnosed with anxiety, she took the medicines sertraline, fluvoxamine, fluoxetine, citalopram, escitalopram, and olanzapine, without satisfactory results. Treatment was started on clomipramine 25mg, and the dose was increased monthly to 75mg and 125mg. The patient reported progressive improvement, except in the menstrual period, and the dose was increased to 175mg. The dose returned to 125mg due to side effects (flatulence and urinary retention). In the following months, the patient exhibited lower levels of anxiety and reduction in trichotillomania. The area of alopecia measured 11x8 cm and regressed significantly (Figure 1).Takei ( 2000) achieved an improvement in TTM symptoms with low-dose clomipramine treatment (30mg/day), and the patient returned to her daily activities after four months of treatment.

Being under 25 years old (Odds Ratio [OR]=2.13; Confidence Interval [CI95%]=1. 03-4.41, p=0.043), being enrolled in an undergraduate program (OR=2.86; CI95%=1.01-7.69, p=0.045) and being in the adjustment phase (OR=9.72; CI95%=3.30-28.61, p<0.001) increase the student's chances of exhibiting SIPSII (Table 1). The undergraduate degree period, under the age of 25, reveals that immaturity may limit the student's ability to cope with new situations (Campos et al., 2017).Suicide attempt rates are higher among students in the adjustment phase (OR=5.01; CI95%=1.21-20.67, p=0.043), students that experienced adverse childhood events (OR=6.80; CI95%=1.74-26.52, p=0.013) or who smoke (OR=3.89; CI95%=1.17-12.90; p=0.034), according to Table 2. Evidences that smoking (Poorolajal and Darvishi, 2016) and sexual abuse in childhood (Bahk et al., 2017) increases the likelihood of a suicide attempt in students were wellreported.

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