A 32-year-old woman compulsively pulls her hair from the scalp, resulting in noticeable patchy alopecia. She feels tension before pulling and relief afterward. She is embarrassed and has avoided social situations for 6 months. Which DSM-5 diagnosis BEST fits?

• A OCD with hair-related obsessions
• B Alopecia areata with psychological overlay
• C Body Dysmorphic Disorder
• D Trichotillomania (Hair-Pulling Disorder) ✓

Explanation

Trichotillomania (Hair-Pulling Disorder), classified under OCD and Related Disorders in DSM-5, is characterized by recurrent compulsive hair pulling resulting in hair loss, repeated attempts to decrease or stop hair pulling, and clinically significant distress or functional impairment. The tension-relief cycle (tension before pulling, gratification/relief after) is a classic feature. It differs from OCD in that hair pulling is not driven by an obsessional thought but by a body-focused repetitive behavior. First-line treatments include habit reversal therapy (HRT) and N-acetylcysteine pharmacologically.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.