Trichotillomania DSM IV Criteria

A. Recurrent pulling out of one’s hair resulting in noticeable hair loss.

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

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

D. 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).

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

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Diagnostic Features

The essential feature of Trichotillomania is the recurrent pulling out of one’s own hair that results in noticeable hair loss (Criterion A). Sites of hair pulling may include any region of the body in which hair may grow (including axillary, pubic, and perirectal regions), with the most common sites being the scalp, eyebrows, and eyelashes. Hair pulling may occur in brief episodes scattered throughout the day or in less frequent but more sustained periods that can continue for hours. Hair pulling often occurs in states of relaxation and distraction (e.g., when reading a book or watching television) but may also occur during stressful circumstances. An increasing sense of tension is present immediately before pulling out the hair (Criterion B). For some, tension does not necessarily precede the act but is associated with attempts to resist the urge. There is gratification, pleasure, or a sense of relief when pulling out the hair (Criterion C). Some individuals experience an “itchlike” sensation in the scalp that is eased by the act of pulling hair. The diagnosis is not given if the hair pulling is better accounted for by another mental disorder (e.g., in response to a delusion or a hallucination) or is due to a general medical condition (e.g., inflammation of the skin or other dermatological conditions) (Criterion D). The disturbance must cause significant distress or impairment in social, occupational, or other important areas of functioning (Criterion E).

Associated descriptive features and mental disorders

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.

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