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The diagnostic criteria for Trichotillomania includes the following:

  • Recurrent pulling out of one's hair resulting in noticeable hair loss.

  • An increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior.

  • Pleasure, gratification, or relief when pulling out the hair.

  • The disturbance is not better accounted for by another mental disorder and is not due to a general medical condition (e.g., a dermatological condition).

  • The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

    Associated Features

    Examining the hair root, twirling it off, pulling the strand between the teeth, or trichophagia (eating hairs) may occur with Trichotillomania. Hair pulling does not usually occur in the presence of other people (except immediate family members), and social situations may be avoided. Individuals commonly deny their hair-pulling behavior and conceal or camouflage the resulting alopecia.

    Some individuals have urges to pull hairs from other people and may sometimes try to find opportunities to do so surreptitiously. They may pull hairs from pets, dolls, and other fibrous materials (e.g., sweaters or carpets). Nail biting, scratching, gnawing, and excoriation is often associated with Trichotillomania. Individuals with Trichotillomania may also have Mood Disorders, Anxiety Disorders (especially Obsessive-Compulsive Disorder), Substance Use Disorders, Eating Disorders, Personality Disorders, or Mental Retardation.


      Transient periods of hair pulling in early childhood may be considered a benign "habit" with a self-limited course. Individuals who present with chronic Trichotillomania in adulthood often report onset in early adolescence. Some individuals have continuous symptoms for decades. For others, the disorder may come and go for weeks, months, or years at a time. Sites of hair pulling may vary over time.

        Diagnostic criteria summarized from:

        American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

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