A 22-year-old woman presents with patchy hair loss on her scalp. Examination shows hairs of varying lengths broken at different points, with an irregular border to the bald patch. She admits to repeatedly pulling out her own hair, experiences rising tension beforehand, and feels relief and gratification afterwards. There are no obsessions related to appearance. What is the most likely diagnosis?
- A Trichotillomania (hair-pulling disorder) ✓
- B Alopecia areata
- C Excoriation (skin-picking) disorder
- D Body dysmorphic disorder
Correct answer: A. Trichotillomania (hair-pulling disorder)
Explanation
Recurrent hair pulling preceded by tension and followed by pleasure or relief, with hairs broken at varying lengths, defines trichotillomania. Alopecia areata produces smooth, complete hair loss with exclamation-mark hairs and no preceding urge, which kills that distractor. Skin-picking disorder involves picking at skin rather than hair, and body dysmorphic disorder requires preoccupation with a perceived appearance defect driving the behaviour.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.