A 16-year-old girl presents with recurrent, distressing urges to pull out her eyebrow and scalp hair, resulting in visible patches of hair loss. She experiences tension before pulling and relief afterward. She feels ashamed but cannot stop. Which DSM-5-TR diagnosis best fits her presentation?

• A Trichotillomania (hair-pulling disorder) ✓
• B Excoriation (skin-picking) disorder
• C OCD with grooming obsessions
• D Stereotypic movement disorder

Explanation

Trichotillomania is classified under obsessive-compulsive and related disorders in DSM-5-TR. It is characterised by recurrent pulling of one's own hair resulting in hair loss, repeated attempts to decrease or stop the behaviour, and clinically significant distress or impairment. The tension-relief cycle (tension before, relief after pulling) is a classic associated feature, though not required by DSM-5-TR criteria. Excoriation disorder involves skin-picking rather than hair-pulling. Habit reversal training is the psychological treatment of choice.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.